Midwest Counterdrug Training Center

Iowa Department of Public Health: Substance Abuse Prevention Ethics Recertification Webinar
Thursday, May 2, 2019
09:00 AM - 12:00 PM
Location: WEBINAR

STUDENT CONTACT INFORMATION
*REQUIRED
First Name:
*

Last Name:
*

Position/Title/Rank:
*

Phone Work: (include area code)*

Cell Phone: (include area code)*

Email Address:
*
NOTE: .mil addresses are currently unable to receive confirmation emails or attachments from MCTC, please input a civilian or commercial email address below*

AGENCY / ORGANIZATION 

Agency/Organization Name:*

Agency Type:*

Agency City:*

Agency State:*
(ie: CA)
Agency Zip code:*

SUPERVISOR/TRAINING MANAGER
Full Name*

Phone Work:* (include area code)

E-mail:*

ADDITIONAL QUESTIONS
Are you currently a member of the US Armed Forces (Active, Reserve, Guard, or Auxiliary)?*


Is your agency/organization a HIDTA participant?
*