Interested in learning more about the Active & Healthy Brotherhood project?

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* 1. What is your name?

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* 2. What is the best phone number to contact you?

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* 3. What is the best time to contact you?

Morning

Afternoon

Evening

Any time

Other (please specify)

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* 4. What is your email address?

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* 5. Do you live in Forsyth County, Mecklenburg County, Guilford County, OR Durham County OR are you willing to travel to Forsyth, Mecklenburg, Guilford, or Durham County, NC to participate in this study?

Yes

No

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* 6. In which county do you reside (or prefer for program participation)?

Forsyth County (Winston-Salem and surrounding areas)

Mecklenburg County (Charlotte and surrounding areas)

Guilford County (Greensboro and surrounding areas)

Durham County (Durham and surrounding areas)

Other (please specify)

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* 7. If you are a study recruiter, please type your name here.