Naloxone Training Workshop: Thurs, Nov 12 Sign-Up Form
Join our naloxone and overdose response training workshop. Please fill out this form to sign up for our next workshop on Thursday, November 12th: 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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