Two Day Webinar:  ROTA Opioid Use Disorder Tribal Technical Assistance Training
Monday, June 29th from 9:00 am to 12:00 pm & Tuesday, June 30th from 9:00 am to 1:00 pm 

 

Full Name: ___________________________________________________________________________________________________________________________

Mailing Address: _____________________________________________________________________________________________________________________

City, State, Zip: _______________________________________________________________________________________________________________________

Agency you represent:________________________________________________________________________________________________________________

Day Phone:____________________________________________________________________________________________________________________________

Email:__________________________________________________________________________________________________________________________________
(*Required – all correspondence will be conducted via e-mail.)

******************STOP HERE, THIS IS AN ONLINE TRAINING.  NO FURTHER INFORMATION IS NEEDED AT THIS TIME**********************************

Breakfast, lunch, refreshments and dinner will be provided. Please inform us of any food allergies, mobility issues or special needs we can accommodate:

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Registration: 
Thanks to federal funding from SAMHSA (Substance Abuse and Mental Health Services Administration), there is no fee for this training. Your registration needs to be received as soon as possible as there is limited space available and registration is on a first come-first served basis.


Hotel & Travel Reimbursements:
Montana State University Extension will provide lodging, meals and mileage reimbursement for attendees.  Please complete the following information below to ensure your needs are met:

____I am requesting lodging for the night before the event, Thursday June 4th, 2020 (only). 

____I am requesting lodging for the night of Friday June 5th, 2020 (only).

____I am requesting lodging for two nights: Thursday June 4th and Friday June 5th, 2020.  

____I am willing to share a room with ________________ in order to maximize the number of rooms available.

____I do not need lodging, or am making my own lodging arrangements. 

____ I am requesting mileage reimbursement and will be driving _____ miles to attend the event.  Mileage will be reimbursed at 0.58 cents per mile. Please see Wendy Stevens at the event to sign 2 forms for reimbursement, IRS Form W-9 and a Reimbursement form. A check will be mailed to you in 30 to 45 days.

Evening gathering and workshop session (5:00-8:30)

____ I will be attending the 5:00 dinner

____I will be attending the 6:30-8:30 workshop session (Indigenous Mindfulness & Selfcare)

____I will be attending both dinner and workshop session

____I will not be attending the evening events

 

Comments:

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Training Agenda:
The training will begin at 8:00 a.m. on Friday, June 5th and will conclude at 4:00 p.m. (evening session will end at 8:30)

Please return this registration form by mail, email, or fax to:

Mail to:
MSU Extension, Jennifer Munter
320 Reid Hall
PO Box 173370
Bozeman, MT 59717

Email to:     [email protected]

Fax to:     call 406-994-3088 for fax number