October 5, 2022 Tribal Nicotine Replacement Therapy Webinar

Registration Form

Northwest Tribal Clinical Nicotine Replacement Therapy Webinar
Date: Wednesday, October 5, 2022
Times: 9:00 am to 11:00 am (PST)
Location: Online Webinar - NPAIHB Zoom

Question Title

* 1. Contact Information

Name: *

Position:

Tribe/Organization: *

Address: *

City: *

State: *

ZIP Code: *

Email Address: *

Phone Number: *

Question Title

* 2. Please Register me for the Northwest Tribal Nicotine Replacement Therapy Webinar

Yes

Question Title

* 3. Do you consent to having your photo taken virtually to promote future NRT trainings?

Other (please specify)

October 5, 2022 Tribal Nicotine Replacement Therapy Webinar

Registration Form

Question Title

* 1. Contact Information

Question Title

* 2. Please Register me for the Northwest Tribal Nicotine Replacement Therapy Webinar

Question Title

* 3. Do you consent to having your photo taken virtually to promote future NRT trainings?

Question Title

* 4. What knowledge are you hoping to gain from this training?

Question Title

* 5. Any Questions or Comments?