In-Person Mental Health First Aid Event Registration

Thank you for your interest in attending our In-Person Adult Mental Health First Aid. Please fill out this survey to get registered.

DATE: Wednesday, August 24th
TIME: 8:30 am - 5:00 pm
LOCATION: First Choice Community Center, Suite 100, Columbia, SC 29212
FEE: No Registration Fee
REGISTRATION DEADLINE: Monday, August 22nd

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* 1. Do you attend a faith-based organization?

Yes

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* 2. Your contact info:

First Name

Last Name

Faith-Based Organization Name

Faith-Based Organization Street Address

City

State

ZIP

County

Email Address

Phone Number

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* 3. By registering for this course, I agree to receive monthly HOTL e-newsletters, text messages and other information on other health-related issues.

Agree

Disagree

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* 4. Faith-Based Organization Demographics: Total Roster Membership

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* 5. Faith-Based Organization Demographics: Number of Active Members 18 and Older

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* 6. Faith-Based Organization Demographics: Number of Active Members Younger than 18 Years

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* 7. Faith-Based Organization Demographic Profile

Mostly European American

Mostly African American

Mostly Other

I am not representing a faith-based organization.

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* 8. Do you have any dietary restrictions? (Select all that apply.)

I do not have any dietary restrictions.

Vegetarian

Vegan/Lactose Intolerance

Gluten Free

Other (please specify)

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* 9. What topics would you most like to learn about at In-Person Adult Mental Health First Aid ?

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* 10. How would you like to receive additional information about In-Person Adult Mental Health First Aid?

Text

Both