Use this survey to register for the Red Lake community opioid overdose prevention and treatment training event scheduled for January 12, 2016.

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* 1. First Name

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* 2. Last Name

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* 3. Preferred Nickname:

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* 4. I am with a tribal program:

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* 5. Tribal department:

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* 6. Position:

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* 7. My email address is:

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* 8. My mailing address is:

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* 9. City:

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* 10. State:

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* 11. Zip code:

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* 12. I am interested in attending the opioid overdose reversal breakout.  I want to get training and leave the event with naloxone (the opioid overdose reversal medication).

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