Exit Living Well Thurston Registration Form April-May 2023 Title: Living Well Thurston WorkshopWhen: Tuesdays, April 11 to May 23, 2023 from 10:00am - 12:30pm To Register: Fill out the information belowThe workshop is offered by Thurston County Public Health and Social Services. For more information contact Lesley Price (360) 480-4654, lesley.price@co.thurston.wa.us Question Title * 1. First and Last Name: Question Title * 2. Contact Information: Mailing Address Phone Email Question Title * 3. Which of the following best describes why you are attending this workshop? To address your chronic health condition To support someone else who has a chronic health condition Other, please describe Question Title * 4. The workshop is offered online. Do you have access to the following technology to participate? Yes No Unsure Desktop or laptop computer Desktop or laptop computer Yes Desktop or laptop computer No Desktop or laptop computer Unsure Webcam (computer camera that allows everyone to see you) Webcam (computer camera that allows everyone to see you) Yes Webcam (computer camera that allows everyone to see you) No Webcam (computer camera that allows everyone to see you) Unsure Microphone/speakers/headphones (audio that allows everyone to hear you and you to hear them) Microphone/speakers/headphones (audio that allows everyone to hear you and you to hear them) Yes Microphone/speakers/headphones (audio that allows everyone to hear you and you to hear them) No Microphone/speakers/headphones (audio that allows everyone to hear you and you to hear them) Unsure WiFi or DSL (any stable internet connection) WiFi or DSL (any stable internet connection) Yes WiFi or DSL (any stable internet connection) No WiFi or DSL (any stable internet connection) Unsure Question Title * 5. Do you currently have health insurance? No Yes, Medicaid or Apple Health Yes, Medicare Yes, employer provided insurance Yes, some other kind of insurance Question Title * 6. How did you hear about the workshop? Question Title * 7. Which best describes your age? 18-34 35-49 50-64 65+ Question Title * 8. Which best describes your gender? Female Male Transgender Done