| Name | Dani Hodge |
|---|---|
| Email Address | Email hidden; Javascript is required. |
| Which class would you like to attend? | Tuesday, April 23rd | 10AM - 11:30AM |
| Are you in the health or first responder workforce? | Yes |
| Address | 125 N 5th ST Mt. Vernon, Washington 98273 Map It |
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| Additional Information | As part of our 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, mailing address, and connection to the health workforce are 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? | 26-35 |
| What is your gender? | Non-binary |
| Are you part of the LGBTQ+ community? | Yes |
| What is your race/ethnicity? (select one) | White |
| Are you Latino(a)? (select one) | No |
