Name *

First Name

Last Name

Phone *

(###)

###

####

Dietary Requirements *

This will not affect your selection but we need to know for meal logistics.

None

Vegetarian

Vegan

Gluten Intolerant

Lactose Intolerant

Other (Describe below)

Advanced Facilitator Training *

CHSE will be offering an Advanced Facilitator Training on October 15, 2020, the day before the start of the Missouri Hope exercise. Topics will include exercise facilitation, leadership development, the coach/teach/mentor/train model, and the way these concepts are applied within CHSE based exercises This will be a full day leadership training prior to the regular exercise. Content would be provided by the Center for Creative Leadership. This training would start at 8:00 AM on Thursday October 15, 2020, and end at roughly 4:00 PM. All individuals attending the training would arrive the night before (Wednesday, Oct 14, 2020), with no extra fee.

Yes

No

Aknowledgement *

Please electronically check each statement acknowledging that you have read and agree to the following:

If selected, I agree to arrive at the exercise no later than start of staff training (as indicated on the info paper), and depart from the site no earlier than end of exercise

If selected, I agree to pay the staff participation fee (online via credit card) to cover the costs of my meals during the exercise.

If selected, I agree to participate in required FEMA courses, review required readings, and participate in online training sessions as requested by Senior and Executive staff.

If selected, I agree to fully abide by all exercise policies.

I understand that a photo release form is required in order to participate as a staff member in the Missouri Hope Exercise