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* 1. First Name, Last Name

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* 2. Email address

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* 3. Job Title

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* 4. Company/Organization

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* 5. Gender

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* 6. Age group

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* 7. Racial Identity

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* 8. Please indicate your occupational field

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

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

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* 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

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