First Name*

Last Name*

Street Address*

City*

State*
Please Select State Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Marianas Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming

Zip code*

Phone*

Arrival Date*
Please Select Arrival Date 26 November 2011 27 November 2011 28 November 2011 29 November 2011 30 November 2011 31 November 2011 01 December 2011

Departure Date*
Please Select Departure Date 01 December 2011 02 December 2011 03 December 2011 04 December 2011

Position*
Please Select Position Consultant DVOP LVER Other

Email*

1. How long have you been teaching TAP courses?*
Please select one Less than 1 year 1-4 years 5-8 years More than 8 years

2. How often do you teach TAP courses?*
Please select one Daily Weekly Monthly Occasionally

3. What is your educational background?*
Please select one Bachelor's Master's Certification or training as an instructor

4. What training/education have you received that has improved your skills as a trainer?*
Please select one Formal education (degree or certificate) Some training On-the-job training None

5. What other training have you taught besides TAP?*

6. What do you hope to gain from attending this workshop?*