Workshop Change Form This form should be submitted for all workshop changes/updates including cancelled workshops. Organizations and facilitators should complete the workshop change form as soon as the new information is available. Please provide the information listed on the original registration.Name* First and Last Email* Phone*Original Host Facility Name Original Workshop Start Date MM slash DD slash YYYY Please select each field that changes will need to be made. Choose all that apply.CDSMP? CDSMP CDSMP CDSMP Live! (Virtual) CDSMP @ Home (Toolkit with Weekly Leader Calls) CDSMP (In-person *prior approval required*) Tomando Control de su Salud? Tomando Control de su Salud Tomando Control de su Salud Tomando Control de su Salud Live! (Virtual) Tomando Control de su Salud (In-person *prior approval required*) DSMP? DSMP DSMP DSMP Live! (Virtual) DSMP @ Home (Toolkit with Weekly Leader Calls) DSMP (In-person *prior approval required*) CPSMP? CPSMP CPSMP CPSMP Live! (Virtual) CPSMP @ Home (Toolkit with Weekly Leader Calls) CPSMP (In-person *prior approval required*) CTS? CTS CTS CTS Live! (Virtual) CTS (In-person *prior approval required*) wCDSMP? wCDSMP wCDSMP wCDSMP Live! (Virtual) wCDSMP (In-person *prior approval required*) WWE? WWE WWE Take A Steap & Walk With Ease (Virtual) Walk With Ease (In-person) F&S? F&S F&S Fit & Strong @ Home (Virtual) Fit & Strong! (In-person) Please select each field that changes will need to be made. Choose all that apply. Workshop Type Location Start Date End Date Facilitator Change Workshop Cancelled New Workshop Type*BCBH Chronic Disease (CDSMP)BCBH Diabetes (DSMP)BCBH Chronic Pain (CPSMP)BCBH Cancer: Thriving and Surviving CTSBCBH Worksite Chronic Disease (wCDSMP)Walk With Ease (WWE)Fit & Strong (F&S)Tomando Control de su SaludNew Location Address* Street Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code New Start Date* MM slash DD slash YYYY New End Date* MM slash DD slash YYYY Co-facilitator #1 (FIrst/Last Name) Co-facilitator #2 (FIrst/Last Name) Co-facilitator #3 Substitute (FIrst/Last Name) Cancelled Host Facility Name* Cancelled Workshop Type*BCBH Chronic Disease (CDSMP)BCBH Diabetes (DSMP)BCBH Chronic Pain (CPSMP)BCBH Worksite Chronic Disease (wCDSMP)BCBH Cancer: Thriving and Surviving (CTS)Walk With Ease (WWE)Fit & Strong (F&S)Tomando Control de su SaludAdditional Questions or CommentsCAPTCHAEmailThis field is for validation purposes and should be left unchanged.