Workshop Change Form

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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*
New Location Address*
Street Address City State 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*
Additional Questions or Comments
CAPTCHA
Name
This field is for validation purposes and should be left unchanged.