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The following form allows you to request Naloxone Training. Please Note - Trainings can be conducted remotely through ZOOM, or in person. Social distancing and wearing facial masks are required when in-person trainings are conducted.
Group/Individual Training - Region 5N1 (Cheatham, Dickson, Houston, Humphreys, Montgomery, Robertson, Stewart, Sumner)

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* Date.

Date

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* I am requesting

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* Type of Organization (leave blank if NOT requesting group training)

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* Name of Organization (leave blank if NOT requesting group training)

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* # of Staff (leave blank if NOT requesting group training)

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* # of Locations (leave blank if NOT requesting group training)

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* Name

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* Business Address

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* County

You must reside in one of the counties listed above in order for you to receive Naloxone training and/or a Naloxone kit from Region 5N1 ROPS. If you do not, click here and reach out to the ROPS representative in your county.

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* Preferred Method of Contact

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* Phone

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* Are there any additional comments/​information you would like to share about your request? ex. Did you speak with a specific ROPS? Do you need a follow-up training session for someone who was not able to make it to the scheduled class?

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* Do you have access to a virtual platform, (i.e. Zoom, Webex, Microsoft Teams?)

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* Which days are best for you?

Allow one (1) hour for Zoom training.

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* What is the best time of day for training?

Select multiple time slots to expedite the scheduling process.

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