Terms and conditions:
We require that all trainings be held in handicapped accessible locations. The Host Facility will provide accomodations for participants with disabilities. The Host facility will provide copies of relevant existing documents within the agency and outside of the agency (for example emergency operations plans in each county, hospital) for instructor review prior to the training and copies for participants. If interpreters are needed that will be the responsibility of the agency/facility. Payment is due at the time the contract is signed. The agency/facility will provide site location, refreshments, registration, audiovisual equipment including laptop and power point projection with technical assistance during the presentations/seminar. . No videotaping or audiotaping is permitted unless authorized. Instructor expenses will be billed as actually accrued on a monthly basis and are due on receipt of our invoice. Reasonable travel expenses include full coach airfare, train, taxi, hotel, meals, mileage and tips.
Training dates are set at the time the contract is signed and payment is made. We request a minimum of two weeks prior to the training date unless emergency situations are in operation. 30 days notice in writing is required to reschedule a training date. The instructor reserves the right to reschedule in the event of national emergency declaration. Please make check payable to "CDRC Disaster Training and Consulting Division". The NRV CDRC, a disaster relief organization, operates under the auspices of A-kee, Inc. a private, nonprofit corporation, (501 (C) (3)) dedicated to mental health service and education at the grassroots level.
The NRV CDRC retains all copyright and licensing rights to disaster mental
health training materials developed prior to, during or after the training..
The NRV CDRC may include co-instructors who are becoming certified trainers
REGISTRATION FORM
| Course | Check Desired Course |
Cost per training |
Dates Requested |
| Disster Mental Health 101 |
$2500.00 | ||
| DMH in the Community |
$1000.00 | ||
| (201)DMH with Children (202)Special Populations (203)Disaster Support in Education Settings (204)Trama Assesment (205)Clinical Interventions (206)Organizing a Disaster Mental Health Response (207)Quarantine and Pandemic Events (208) Faith Based Disaster Support (4 hours) |
(201) (202) (203) (204) (205) (206) (207) (208) |
$1500 " " " " " " " " " " " " $1800 |
|
| Medical Facility Program |
$2000.00 | ||
| DMH(300) Training the Trainers |
$7500.00 | ||
| Total Due: When contract is signed(attach check to registration form) |
Name of Facility/Agency ______________________ ---------PRINT OUT REGISTRATION
FORM, COMPLETE AND ATTACH CHECK
Contact Person Name _________________________ ------ MAIL TO: DR. D. MILLER
Phone_________ e-mail_______________ ------------------ -----------420 SPRINGDALE
RD.
Address ______________________________________ ---------------PEARISBURG, VA
24134
______________________________________
______________________________________
List requested training dates in order of preference: 1.______ 2. _____ 3._____
Fax completed pages 6, 7 and 8 to 540-921-3312.
Dates will be scheduled when payment is received.
SIGNATURE PAGE
Acceptance: The signatures below indicate acceptance of the details, terms
and conditions in this contract as specified above.
For NRV CDRC Disaster Training Services:
________________________________
Dorinda Miller, Ph.D. President
Date: _________
For : ___________________________
Agency/Facility
________________________________
Director
__________________________________
Printed name
Date: _________
This contract serves as an invoice.