Workshop Request Form Workshop Setup Serna [kh879] Meeting Creation Form This request form is to be filled out after you have created the meeting/workshop in Zoom. This information is for Keap and for the website. Requests for meeting set up require a minimum of 48 hours advanced notification. Workshop Name (to be used on website) * Workshop Description * Workshop Category * Cat 4 -NNM Rural Health Network Training Cat 5 - Serna Exclusive Training Cat 6 - NM SOR Grant Training Cat 7 - State of NM Sponsored Training Cat 8 - Hidalgo Medical Center Exclusive Workshop for Organization? * No Yes If yes, enter name of Organization Workshop Images, Headshots, Bios (can upload multiple files) Drop a file here or click to upload Choose File Maximum upload size: 104.86MB Choose Trainer(s) * Mary Evans Emily Everhart Luke Higgins Brianna Jacobson Jennifer Nanez Jennifer Padilla Brian Serna Chris Chickering Other/I have uploaded a new bio and headshotOther/I have uploaded a new bio and headshot Workshop Format Workshop Format * Online In Person Location of Event (In-Person Events) Location of Event (In-Person Events) Location of Event (In-Person Events) Location of Event (In-Person Events) City City State/Province State/Province Zip/Postal Zip/Postal Country Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Côte d'Ivoire Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Country Workshop Name (In Zoom) Meeting ID Meeting Registration Link Meeting Passcode Workshop Length * Half Day One Day Two Days OtherOther Meeting Date Start * Meeting Start Time (MST) * 121234567891011 : 0030 AMPM Meeting End Time (MST) * 121234567891011 : 0030 AMPM Meeting Date End * Link to Survey (to be sent to participants) Email of person requesting this workshop setup * If you are human, leave this field blank. Submit
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