MAPHTC:Health Forum- Sign-In Sheet - 06/25/10
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1. Sign-in Sheet
. First & Last Name or Organization Name
First & Last Name or Organization Name
. Did you watch this webcast with other people?
Did you watch this webcast with other people?
If yes how many other people did you watch with?
. In which of the following disciplines do you practice? (Please check only ONE)
In which of the following disciplines do you practice? (Please check only ONE)
Communtiy Health Worker
Mental Health & Substance Abuse
Public Health Law
Public Helath Policy
. In what type of organization do you work?
In what type of organization do you work?
City Health Department
County Health Department
Tribal Health Department
Public Health Community Based Organization
State Health Department
. What is your gender and age?
What is your gender and age?
Male- Under 20
Male- 60 or older
Female- under 20
Female- 60 or older
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