Region 5 Suicide Advisory Board Membership Roster
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1.
First name
(Required.)
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2.
Last name
(Required.)
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3.
Email
(Required.)
4.
Phone
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5.
Organization/Agency
(Required.)
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6.
Job Title/Role
(Required.)
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7.
What town(s)/region do you/your organization support?
(Required.)
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8.
What sector do you best represent?
(Required.)
Youth
Parent
Business
Healthcare
Media
School
Youth serving organization
State or local government
Law enforcement
Religious/fraternal organization
Civic/volunteer organization
Substance abuse organization
9.
Please share any resources, skills or expertise you or your organization possess that may support the work of the R5SAB.
10.
Please share any areas of interest you are looking to learn more about, receive training in, present on, etc.
Current Progress,
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