Participants MUST be registered Native patient at LCTHC to qualify for this event.

This event honors Natives in Recovery and participants who are interested in sobriety and resources.


Thank you for registering promptly.

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* 1. If you are a vendor please click link to register https://www.surveymonkey.com/r/R76FMLD

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* 2. Are you a registered Lake County Tribal Health patient?

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* 3. Are you currently in recovery or interested in recovery support?

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* 4. Full Legal Name

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* 5. Date of Birth

Date

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* 6. Please enter a valid contact information

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* 7. Tribal Affiliation

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* 8. Age Range

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* 9. Please enter your first date of sobriety

Date

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* 10. Please enter the length of sobriety (Years, Months, Days, Hours) *Optional 

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* 11. Would you like to submit a video to share online for the event?

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* 12. Please select your shirt size

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