Rural DELTA Day Sign Up

After completing this form, you and your team will receive calendar appointments for all meeting and webinar dates.


  1. Prep Webinar: August 4, 9am - 10am
  2. Safe Table DELTA Day: September 25, 8:30am - 3pm, WSHA Office, Seattle
  3. ACCELERATE Webinars:
  • October 27, 9am - 10am
  • November 28, 9am - 10am
  • January 9, 9am - 10am

Main Contact Details

Enter contact information for the primary contact for your participating team.

Team Member Details

If you know which additional team members you are bringing, please provide their contact information below. You may bring up to five total team members (including yourself). You may add team members later if you don't know yet.

Total team members who will attend, including yourself. If not yet known, please estimate.

name, title, email

name, title, email

name, title, email

name, title, email

Project Information

Please briefly describe the quality improvement project, problem or priority that you are interested in workshopping during this DELTA Day. You may leave blank if this is not yet determined.

Commitment Form

Please sign and attach this form indicating your commitment to participate. This should also be signed by a supervisor.

Drag and drop files here or

Other information

Please add any additional comments, clarifications, or questions that you have