Black Opportunity Fund's National Black Health Town Hall Session 3: Capitalizing on Black People's Strengths, Black Health Leaders and Health Professionals to Improve Health Service Delivery

Registration Form

Date: July 18 2024

Time: 6-8 pm EST

This is a virtual event

Please complete the form below to secure your spot.

To ensure an integrated critical race and intersectional perspective, we are collecting demographic information from participants, including age, gender and country of birth, for themselves and their parents. An evaluation of each session will be completed with a focus on satisfaction and reflection.

Thank you,

The Black Opportunity Fund Team

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* 1. First Name

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* 2. Last Name

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* 3. Email Address

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* 4. Please Enter Your Address

City/Town

State/Province

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* 5. Gender

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* 6. Which age range applies to you?

19 and under

20-29

30-39

40-49

50-59

60-69

70-79

80+

Black Opportunity Fund's National Black Health Town Hall Session 3: Capitalizing on Black People's Strengths, Black Health Leaders and Health Professionals to Improve Health Service Delivery

Registration Form

Question Title

* 1. First Name

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* 2. Last Name

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* 3. Email Address

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* 4. Please Enter Your Address

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* 5. Gender

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* 6. Which age range applies to you?

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* 7. Which statement best describes you?

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* 8. Industry of Employment

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* 9. Which of the following best describes your ethno-racial identity?

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* 10. Country of Birth

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* 11. Mother's Country of Birth

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* 12. Father's Country of Birth

Black Opportunity Fund's National Black Health Town Hall Session 3: Capitalizing on Black People's Strengths, Black Health Leaders and Health Professionals to Improve Health Service DeliveryRegistration Form

Question Title

* 1. First Name

Question Title

* 2. Last Name

Question Title

* 3. Email Address

Question Title

* 4. Please Enter Your Address

Question Title

* 5. Gender

Question Title

* 6. Which age range applies to you?

Question Title

* 7. Which statement best describes you?

Question Title

* 8. Industry of Employment

Question Title

* 9. Which of the following best describes your ethno-racial identity?

Question Title

* 10. Country of Birth

Question Title

* 11. Mother's Country of Birth

Question Title

* 12. Father's Country of Birth

Black Opportunity Fund's National Black Health Town Hall Session 3: Capitalizing on Black People's Strengths, Black Health Leaders and Health Professionals to Improve Health Service Delivery

Registration Form