*1.First and Last Name(Required.)

*2.Email Address(Required.)

3.Credentials

*4.Job Title(Required.)

*5.Clinic or Organization(Required.)

Adapt Integrated Health CareAsher Community Health CenterAviva HealthCentral City ConcernClackamas County Community Health DivisionCoast Community Health CenterColumbia River Community Health ServicesCommunity Health Centers of Benton and Linn CountiesCommunity Health Centers of Lane CountyKlamath Health PartnershipLa ClinicaLa Pine Community Health CenterCoastal HealthcareMosaic Community HealthMultnomah County Community Health CentersNative American Rehabilitation AssociationNehalem Bay Health CenterNeighborhood Health CenterNorthwest Human ServicesOHSU Family Medicine at RichmondOne Community HealthOutside InRogue Community HealthSiskiyou Community Health CenterTillamook County Health DepartmentValley Family Health CareVirginia Garcia Memorial Health CenterWallaceWaterfall ClinicWhite Bird ClinicWinding Waters ClinicYakima Valley Farm Workers ClinicCascadia Behaviorial HealthcarePrism Health / Cascade AIDS ProjectOther (please specify)

*6.Work Zip Code(Required.)

*7.Work County
If you work in more than one county, please choose the one you work in the most, or where your base is.(Required.)

BakerBentonClackamasClatsopColumbiaCoosCrookCurryDeschutesDouglasGilliamGrantHarneyHood RiverJacksonJeffersonJosephineKlamathLakeLaneLincolnLinnMalheurMarionMorrowMultnomahPolkShermanTillamookUmatillaUnionWallowaWascoWashingtonWheelerYamhill

*8.State(Required.)

9.What challenges have you faced with REALD and SOGI demographic data collection?

10.What do you hope to learn at this workshop?