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Get Requested Training Date: Name: Title: Municipality: Agency ... - Ct

Rstanding of Internet Explorer and computer usage. After registering in the online format, please complete the following form and have it signed either by your supervisor (State Agencies Only) or by your CEO, EMD or Chief of Service (Municipal or Private Sector). You can then fax it to 860-706-5539. Attention: Bob Scata You will not be accepted into WebEOC Training until this form is received at DEMHS and confirmation has been sent back to you via email. Requested Training Date: Name: Title: Mu.

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