1.First Name, Last Name

2.Email address

3.Job Title

4.Company/Organization

5.Gender

6.Age group

Under 18

18-24

25-34

35-44

45-54

55-64

65+

7.Racial Identity

8.Please indicate your occupational field

Public safety/criminal justice

Higher Education/Post-secondary education

Social Services 

Personal Development 

Caregiver/family member

Mental Health Professional

Public Health

9.Please check which Lunch and Learn Series you would like to attend (you can select multiple options)

Walk a Mile in Someone Else's Shoes on 6/15 from 12-1pm

Working Across Cultures: Stepping Out of Your Comfort Zone on 7/20 from 12-1pm

Lost in Translation: Language and Trauma on 8/3 from 12-1pm

What's Wrong? Figuring out Cross-Cultural Misunderstandings- Thursday, 9/21 from 12-1pm

10.Please choose the county in Maine where you live/and or work

Cumberland County

Sagadahoc County

None of the above

11.Please note that this is a live virtual training and will not be recorded. You will receive a zoom link to the training 1-2 weeks after registering. You can submit any questions here or email us at: midcoastchi@mainehealth.org