Exit

April 25 & 26, 2023 Second Wind Tobacco Cessation Training registration

1. Registration Form

Second Wind Tobacco Cessation Training
Date: Tuesday, April 25, 2023 Time: 9:00am to 4:00pm

Date: Wednesday, April 26, 2023 Time: 9:00am to 1:00pm

Location: Chiloquin, Oregon

Question Title

* 1. Contact Information

Name:

Position:

Tribe/Organization:

Address:

City:

State:

ZIP Code:

Email Address:

Phone Number:

Question Title

* 2. Photo Release

By checking this box, you are authorizing the Northwest Portland Area Indian Health Board, as well as its collaborating partners to utilize any photographic images taken at the training to be used for promotional purposes.

April 25 & 26, 2023 Second Wind Tobacco Cessation Training registration

1. Registration Form

Question Title

Question Title

* 1. Contact Information

Question Title

* 2. Photo Release

Question Title

* 3. What food considerations do you have? (Vegetarian, Vegan, Allergies, or other)

Question Title

* 4. Are you requesting a travel scholarship?

Question Title

* 5. Any Questions or Comments?