SMART for First Responders Registration- Lakeway, TX September 20, 2024 Survey

Registration

Thank you for your interest in the HEART 9/11 SMART Training for First Responders, a program adapted from the Stress Management and Resiliency Training Program, Benson-Henry Institute for Mind-Body Medicine, Mass. General Hospital, Harvard Medical School. We are looking forward to this training and we hope you are too. When you have a moment, please fill out this registration form. This registration is for the training taking place in Lakeway, TX on Friday, September 20, 2024. This is an full day training (8-hours with breaks throughout the day). Your SMART instructors will be Kate Powell and Ricky Jones. We will contact you once we get closer to the date to provide you with the location and time of the training.

1.Name (First & Last Name)

2.Registrant Email Address

3.Department Location (City and State)

5.Years on the Job

6.Specialized Training

Yes

7.What is your gender?

Female

Male

Other (specify)

8.Which race/ethnicity best describes you? (Please choose only one.)

Multiple ethnicity / Other (please specify)

9.What is the highest degree or level of education you have completed?

Bachelor's Degree

Master's Degree

Ph.D. or higher

Other (please specify)

10.Did some one refer you to this program? If so, please include name or department.