Request a PD Day

Unit-Ship-Squadron:

Name:

Email address:

Are you a Unit Health Promotion Rep?:

Yes
No

If no, who is your Health Promotion Rep?:

Date of briefing (preferred):

Date of briefing (alternate):

Location:

Start time:

Length (min 30 minutes):

Topic:

Equipment/Tech available (check all that apply):

Topic Details to be focused on:

Number of participants:

Make up of participants (check all that apply):

Would you like a copy of the presentation in advance?:

Yes
No

Are there any special security issues that we should be aware of?:

Sometimes units invite us in as a result of a recent issue. Please let us know if there is anything we should be aware of in advance of this event so we can approach the topic with increased sensitivity.:

Number of Registrants:

Alert Notifications