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* 1. First and Last Name:

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* 2. Email address:

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* 3. Phone Number:

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* 4. Would you be interested in participating or learning more about PACES?

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* 5. Would you like someone from the EFEPA to contact you?

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* 6. Best time(s) to contact you:

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* 7. How would you like to be contacted?

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* 8. Would you be willing to participate in 8 weekly virtual sessions?

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* 9. What day & time for a weekly PACES meeting would work best for you?

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* 10. Which topic most interests you? (These are the PACES weekly topics)

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