Thank you for your interest in attending an upcoming Narcan Training. Please fill out this survey to register for a session. For additional questions, please reach out to the Overdose Response Team at Overdoseresponseprogram@montgomerycountymd.gov


 

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* 1. Your information

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* 2. Race/Ethnicity(Select all that apply.)

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* 3. Gender

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* 4. Age Group

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* 5. What is the reason for attending Narcan Training ?

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* 6. If you are 18 yrs and older and would like to receive a Narcan kit after training, please indicate how you would like to receive it?

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* 7. If you wish to have the kit shipped to you, please provide your shipping address:

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