Registration Form Complete and Turn In This Page Registration Deadline is September 23 rd, 2013 Please print legibly. Contact Information Name: Male: Female: Mailing Address: Phone: City: State: Zip: Email address: Home/Chapter Office: SABA username or ID numbers (if unknown, please ask your local chapter): Lodging Information How many nights will you be staying? Indicate which nights you will be staying: Wednesday: Thursday: Friday: Saturday: Rooms will be doubled up. Couples can room together; otherwise you will be roomed with another person of the same gender. If you would like us to try and room you with someone specific that is also attending the Disaster Training Conference please indicate that here: Name of preferred roommate: Questions? If you have any questions please contact Melisa Myers, melisa.myers@redcross.org, 608-232-7465 Send Registration Forms To: Mail: American Red Cross, Attention Melisa Myers, 2927 Losey Blvd, La Crosse, WI 54601 Fax: 608-787-8507 Email: melisa.myers@redcross.org
Course Sign Up Form Complete and Turn In This Section Please indicate with a 1, 2, or 3 for your first, second, or third choice for each session. We will try to accommodate first choices selections. Please note the pre-requisites for each course. When registering for courses with multiple sessions, you must attend all sessions of that course in order to receive completion. You will receive confirmation of your enrollments for courses. The tracks you see are to help you follow an area of interest. The class level designates basic level or advanced level courses. The following is a breakdown of the acronyms in the tracks and level of the course: Track Track Course Level All: Recommended for all Activities LG: Government Operations B: Basic Level MC: Mass Care DAT: Disaster Action Team A: Advanced OM: Operations Management SAF: Service to Armed Forces DHS: Disaster Health Services ERV: Emergency Response Vehicles DMH: Disaster Mental Health SS: Staff Services Advance Level Courses: If you are signing up for Leadership Development Training or Fundamentals of Chapter Disaster Operations Management, you will need to fill out the Disaster Training Application (form 5898H). This form is attached as a separate document. Health and Mental Health Courses: If you sign up for Foundations of Disaster Mental Health or Health Services, please make a copy of your state license and attach it to your registration forms. Example Some Day, Month 16th Example 8:00 PM - 12:00 PM 3 HS Cartoon First Aid/CPR B 1 DA Foundations of Banana Split Assessment B CC Canine Casework B 2 ALL Mass Waiting II A
Wednesday, October 16th 6:00 PM - 10:00 PM FULL ALL Adult First Aid/CPR/AED B ALL Weapons of Mass Destruction/Terrorism: Overview B Thursday, October 17th 8:00 AM -12:00 PM HS Health Services Responses Workshop B OM Leadership Development Training (Session 1 of 4) A DAT Client Casework (Session 1 of 2) B FULL ALL Collaborating Essentials (Session 1 of 2) B MC Shelter Fundamentals B 1:00 PM - 5:00 PM MC Shelter Fundamentals Exercise (1:00 pm - 6:00 PM) B HS Functional Needs Workshop B ALL Psychological FA B OM Leadership Development Training (Session 2 of 4) A DAT Client Casework (Session 2 of 2) B FULL All Collaborating Essentials (Session 2 of 2) B 6:00 PM- 10:00 PM FULL DAT Detail Damage Assessment (7:00 PM-10:00 PM) B ALL Volunteer Connection Demonstrations (6:00 PM-7:00 PM) B SS Staff Services: Operational Data Maintenance (7:10-8:10) B SS Staff Services: Staff Requests (8:15 PM-9:15PM) B
Friday, October 18 th 8:00 AM -12:00 PM DMH Foundations of Disaster Mental Health B HS Shelter Workshop for Health Services B ERV ERV: Review (9:00 AM- 12:00 PM) B FULL DST Disaster Services Technology Overview (8:00 AM-9:00 AM) B FULL DST Disaster Services Technology Communication Workshop (9:10 AM-10:10 AM) B FULL DST Disaster Services Technology Computer Operations Workshop (10:15AM-12:00 PM) B MC Disaster Frontline Supervisor & Simulation (Session 1 of 2) B OM Leadership Development Training (Session 3 of 4) A 1:00 PM-5:00 PM ERV ERV: Ready, Set, Roll (1:00 PM- 6:00 PM) B SAF SAF: The Art of Helping (1:00 PM- 6:00 PM) B DAT DAT Communication Tools B ALL Psychological First Aid B DST Disaster Services Technology Customer Services Workshop (1:00 PM-3:00 PM) B DST Disaster Services Technology Networking Workshop (3:15 PM-5:00 PM) B MC Disaster Frontline Supervisor & Simulation (Session 2 of 2) B OM Leadership Development Training (Session 4 of 4) A 6:00 PM-10:00 PM ALL Disaster Cycle Re-engineering Session (6:30 PM-8:30 PM) B
Saturday, October 19 th 8:00 AM-12:00 PM MC Shelter Management (Session 1 of 2) B DST DST: The Local Program-The Local Response (8:00am-1:00pm) B SAF SAF: Closing the Loop: An Introduction to Family Follow-Up B MC Supply Fundamentals B ERV ERV-stravaganza Skills Test Event (Morning Session) B SS Staff Services: Deployment (8:30 AM -9:30 AM) B SS Staff Services: Profile Management (9:45 AM- 10:45 AM) B SS Staff Services: Initial Operations (11:00 PM-12:00 PM) B OM Fundamentals of Chapter Disaster Operations Management (Session 1 of 3) A ALL Public Affairs Communication Workshop (Session 1 of 2) B LG Government Operations (Session 1 of 2) B ALL Psychological First Aid NEW ADDED CLASS B ALL Shelter Fundamentals NEW ADDED CLASS B 1:00 PM- 5:00 PM SS Disaster Human Resources Management B ERV ERV-stravaganza Skills Test Event (Afternoon Session) B MC Shelter Management (Session 2 of 2) B OM Fundamentals of Chapter Disaster Operations Management (Session 2 of 3) A All Public Affairs Communication Workshop (Session 2 of 2) B LG Government Operations (Session 2 of 2) B ALL Shelter Fundamentals Exercise (12:00PM-6:00PM) NEW ADDED CLASS 6:00 PM-10:00 PM MC Safe and Well Linking (6:00 PM- 8:00 PM) B
Sunday, October 20th 8:00 AM- 12:00 PM OM Fundamentals of Chapter Disaster Operations Management (Session 3 of 3) A 8:00AM-5:00PM All Client Casework NEW ADDED CLASS B All Collaborating Essentials NEW ADDED CLASS B