Thank you for registering for our Cook Along in partnership with the UAMS Culinary Medicine team. A drawing will be held to provide 20 families with the ingredients needed to make the meal.

OK

1.What is your first name?

2.What is your last name?

3.What is your gender?

MaleFemalePrefer not to answer

4.What is your race? (Mark all that apply)

American Indian or Alaska Native

Asian or Asian American

Black or African American

Native Hawaiian or other Pacific Islander

White or Caucasian

Prefer not to answer

5.What is your email address?

6.Within the past 12 months, you worried that your food would run out before you got the money to buy more?

Always

Usually

Sometimes

Rarely

Never

7.Within the past 12 months, the food you bought just didn’t last and you didn’t have the money to get more?

Always

Usually

Sometimes

Rarely

Never

8.I'm interested in learning more about the Southern Ain't Fried Sundays program.

Yes

No

Note: Participants selected to receive the ingredients must come to the Arkansas Minority Health Commission office (5800 W. 10th Street, Suite 805│ Little Rock, AR 72204) for pick up no later than Tuesday, May 23rd at noon. 

Be sure to join us for the Cook Along on Tuesday, May 23rd at 6:00pm via Facebook live. https://fb.me/e/1hzk63ObL