Naloxone Training Workshop: Wed, Sep 9 Sign-Up Form
Join our naloxone and overdose response training workshop on the 2nd Wednesday of each month. Please fill out this form to sign up for our next workshop on Wednesday, September 9th: 6:00-7:30 pm at the GHXCPC office located at 109 W Hastings St. Everyone welcome!
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Please tell us who you are:
*
I am a current GHXCPC volunteer
I am a local resident/ community member
I am with an organization
Other
If you are with an organization, please tell us your organization's name:
What are you most curious to learn about in this training?
What is your current level of knowledge on overdose response and naloxone?
No knowledge
1
2
3
4
Very knowledgeable
5
1 is No knowledge, 5 is Very knowledgeable
Do you consent to potentially being photographed during the workshop (e.g., candid group photos)?
*
Yes
No — If no, please check this box and remind a staff member upon arrival. Thank you for helping us respect your preferences.
Submit
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