12/05/24 10 AM In-Person Adult Mental Health First Aid Event Registration

Thank you for your interest in attending our next In-Person Adult Mental Health First Aid Training. Please fill out this survey to get registered.

DATE: Thursday, December 5, 2024
TIME: 10:00 am - 6:00 pm
LOCATION: Drs. Bruce and Lee Foundation Library 509 S. Dargan St. Florence, SC 29506
FEE: No Registration Fee
REGISTRATION DEADLINE: Tuesday, November 26, 2024

Question Title

* 1. Do you attend a faith-based organization?

Yes

Question Title

* 2. Are you attending this training on behalf of a faith-based organization?

Yes

Question Title

* 3. Your contact info:

First Name

Last Name

Organization Name

Job Title

City

State

ZIP

County

Email Address

Phone Number

Question Title

* 4. By registering for this course, I agree to receive monthly HOTL e-newsletters, text messages and other information on other health-related issues.

Agree

Disagree

Question Title

* 5. Faith-Based Organization Demographics: Total Roster Membership

Question Title

* 6. Faith-Based Organization Demographics: Number of Active Members 18 and Older

Question Title

* 7. Faith-Based Organization Demographics: Number of Active Members Younger than 18 Years

Question Title

* 8. Faith-Based Organization Demographic Profile

Mostly European American

Mostly African American

Mostly Other

I am not representing a faith-based organization.

Question Title

* 9. Do you have any dietary restrictions? (Select all that apply.)

I do not have any dietary restrictions.

Vegetarian

Vegan

Gluten-Free

Lactose Intolerance

Other (please specify)