4/5/2024 AM Virtual Mental Health First Aid Event Registration

Thank you for your interest in attending our Virtual Adult Mental Health First Aid. Please fill out this survey to get registered.

DATE: Friday, April 5, 2024
TIME: 9:00 am - 3:30 pm
LOCATION: Zoom (Link will be provided upon completion of self-pace coursework)
FEE: No Registration Fee
REGISTRATION DEADLINE: Wednesday, April 3, 2024

Note: This virtual course requires you to complete 2 hours of self-pace course work prior to attending the virtual session on 4/05.

Question Title

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

Yes

Question Title

* 2. Your contact info:

First Name

Last Name

Faith-Based Organization Name

Faith-Based Organization Street Address

City

State

ZIP

County

Email Address

Phone Number

Question Title

* 3. 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

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

Question Title

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

Question Title

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

Question Title

* 7. Faith-Based Organization Demographic Profile

Mostly European American

Mostly African American

Mostly Other

I am not representing a faith-based organization.

4/5/2024 AM Virtual Mental Health First Aid Event Registration

Question Title

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

Question Title

* 2. Your contact info:

Question Title

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

Question Title

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

Question Title

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

Question Title

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

Question Title

* 7. Faith-Based Organization Demographic Profile

Question Title

* 8. What topics would you most like to learn about at In-Person Adult Mental Health First Aid ?