Healthy Active Arkansas Community Ambassador Training
Saturday, September 22, 2018
10AM-2:00PM
Arkansas Department of Health - Auditorium - 4815 West Markham, Little Rock, AR 72205

Contact Information

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* 1. Contact Information

Are you a bilingual community health worker

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* 2. Are you a bilingual community health worker

Pageant Affiliation

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* 3. Pageant Affiliation

School Affiliation (if applicable)

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* 4. School Affiliation (if applicable)

Classification (if applicable)

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* 5. Classification (if applicable)

Are you a member of a sorority or fraternity?

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* 6. Are you a member of a sorority or fraternity?

Do you have a disability?

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* 7. Do you have a disability?

Do you have any dietary restrictions?

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* 8. Do you have any dietary restrictions?

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