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REGISTRATION FORM Best Practices in Critical Incident Response in the Workplace (Please print clearly; one Registration Form per person) TRAINER: Dennis Potter, MSW & Judy Behan, MSW DATE: October

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Trainer Dennis Potter MSW is a professional who provides training sessions and workshops on social work related topics.

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Organizations or individuals who have received training from Trainer Dennis Potter MSW and are required to report their attendance or completion of the training.

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Information such as the participant's name, date of training, topic of training, duration of training, and any certification or credits earned must be reported on Trainer Dennis Potter MSW form.