Please fill out all the following information to request a Nutrition Training/Workshop for your organization. After form has been submitted you will receive an email/phone call from the NYCDOHMH nutrition consultant.
Your Name
Your Email Address
Organization Name
Street Address
Borough
Zip Code
Phone Number (xxx-xxx-xxxx)
Audience Type
Day Care Staff
Parents
Adults
Seniors
Teens
Children
Preschoolers
Mixed Audience
Wellness at Work
Number Expected
2-5
6-10
11-15
16-20
20-30
30+
Topic Requested
Label Reading
Diabetes
Teen Nutrition
Food Allergies
Day Care Nutrition
Feeding You Children
Other
If Other, please list:
Date requested (M, W, F only)
Start Time:
Time Allotted:
30 min
45 min
1 hr
1.5 hr
2 hr
2.5 hr
3 hr
>3 hr
Referred by:
Rhonda Johnson
Sabrina Baronberg
Cathy Nonas
Michael Congo
Other
If other, please list how you heard about me:
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