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Overdose Response class registration
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2024-08-07T22:27:10+00:00
Overdose Response Training Registration
Email Address
(Required)
Which class would you like to attend?
(Required)
November 19 | 12-1 pm
November 25 | 11 am -12 pm
December 2 | 12-1 pm
December 17 | 1-2 pm
January 9 | 12-1 pm
January 21 | 2-3 pm
Additional Information
As part of our substance use/misuse prevention program delivery, we gather information to help us understand who is, and who is not, receiving services. The information you provide will be securely stored, will not be shared with other participants, and will be reported without your name or identifying information (aggregated).
Thank you for filling out the following questions honestly and completely. Only your email address is required to attend the training but your complete answers allow us, and our funders, to demonstrate the importance of prevention services to our community.
How old are you?
16-18
19-25
26-35
36-45
46-60
61+
Prefer not to say
What is your gender?
Female
Male
Non-binary
Prefer not to say
Other
Are you part of the LGBTQ+ community?
Yes
No
Don't know
Prefer not to say
What is your race/ethnicity? (select one)
American Indian / Alaska Native
Asian-Chinese
Asian-Filipino
Asian-Japanese
Asian-Korean
Asian-Vietnamese
Black
Native Hawaiian/Pacific Islander
Native Hawaiian/Other Pacific Islander - Samoan
Native Hawaiian/Other Pacific Islander - Other
White
Two or more races (multi-racial)
Prefer not to say
Other
Are you Latino(a)? (select one)
Yes
No
Prefer not to say
What is the Zip Code where you live?
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