Form 0923-0060 EHLR Training Registration

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EHLR Training Registration
Please complete the survey below.
Thank you!

Form Approved
OMB No. 0923-0060
Exp. Date 08/31/2022
Registration Form: Environmental Health and Land Reuse Training
If you do not want to provide your name and email address, which ATSDR uses for registration and issuing
certificates of completion, you may skip this form and may still join in the training as a "drop in" participant.
CDC's privacy policy may be accessed here: https://www.cdc.gov/other/privacy.html 
ATSDR estimates the average public reporting burden of this collection of information as 3 minutes per response,
including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining
the data/information needed, and completing and reviewing the collection of information. An agency may not conduct
or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid
OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of
information including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office; 1600
Clifton Road NE, MS H21-8 Atlanta, Georgia 30333; ATTN: PRA (0923-0060).
1)

My job title is:

2)

Name (First and Last)

3)

Work Email Address

4)

Please select the training you are registering for:

Environmental Health Professional
Environmental Professional
Tribal Environmental Specialist
Planner
Municipal/Tribal Agency Official
Developer
Environmental Non-profit/Non-profit
Citizen/community member
Student in public health, environmental science,
planning, "STEM" discipline
None of the above

__________________________________

__________________________________
EHLR Basic, 10-hour Training (10 CEUs)
EHLR Immersion Training: Community Engagement (8
CEUs)
EHLR Immersion Training: Evaluating Environmental
and Health Risks (8 CEUs)
EHLR Immersion Training: Communicating
Environmental and Health Risks (Risk
Communication) (4 CEUs)
EHLR Immersion Training: Full Training, 3 Modules
(20 CEUs)
(Select the specific type of EHLR training)

Thank you for registering for our upcoming "EHLR" Training.

03/14/2023 1:49pm

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