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Time to Talk 2016
Welcome!
Welcome to the
Time to Talk
registration page! We are very excited to have you participate in the
Time to Talk
campaign. We look forward to hearing from you!
1.
Please provide us with your name
2.
Please provide us with your contact information
Email address
Phone Number
Mailing Address of place of worship
3.
What faith community do you represent?
4.
What is the name of your place of worship?
5.
When will you be speaking to your faith community about health and end-of-life care wishes, values and beliefs?
6.
How many people usually attend your faith gathering?
7.
Please tell us more about your event
8.
Would you like free Advance Care Planning resources to offer your community?
Yes
No
9.
Can we follow up with you afterwards to hear how Time to Talk went?
Yes
No
10.
How did you hear about Time to Talk?
11.
Do you have any questions or comments for us?
