Fentanyl Prevention and Overdose Awareness Day - Volunteer Interest Form
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Pronouns
Where do you work?
Title (if applicable)
What type of volunteering are you interested in? (check all that apply)
Tabling (anytime between 10 a.m. and 6 p.m.)
Speaking (between 4:30 - 6 p.m.)
Training/Education (anytime between 3 and 6 p.m.)
Set up (9 - 10 a.m.)
Tear down (6 - 7 p.m.)
Donating/sponsorship
Other
When are you available to table?
What are you interested in speaking about?
What type of training/education would you like to provide?
What would you like to donate/sponsor?
For tabling, which of the following would you need?
Table
Chairs
Canopy
Other
Will you have harm reduction supplies to provide? (Naloxone/Narcan, Fentanyl test strips, first aid supplies, etc.)
Yes
No
What supplies?
Are you able to provide training/education on how to prevent and or recognize an overdose, administer naloxone/Narcan, test drugs for fentanyl, Medication for Opioid Use Disorder/Medicated-Assisted Treatment (MOUD/MAT), etc.?
Yes
No
What training?
Have resources or information you'd like to share in our powerpoint?
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