September 2020 PG Screening Event

Thank you for your interested in hosting a Problem Gambling Screening Event! Please share your information with us so we can get the screening kit to you! 

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* 1. First, Last Name

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* 2. Agency Name (if applicable)

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* 3. Contact E-mail address

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* 4. Contact Phone Number

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* 5. Have you held a problem gambling screening event in the past? 

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* 6. Are you already connected with your local Problem Gambling Resource Center? 

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* 7. What region of NYS are you located in? 

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* 8. When will you hold your screening event? 

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