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Men's Health Summit Registration Form
Please answer the questions below. As a reminder, there will be free giveaways for those who attend in person. Thank you for joining us!
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1.
What is your First Name?
(Required.)
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2.
What is your Last Name?
(Required.)
3.
What is your phone number? (optional)
*
4.
What is your email?
(Required.)
*
5.
What is the agency, community group, faith-based organization, school, fraternity, or other organization you represent? Please write below. If none, then put N/A.
(Required.)
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6.
What is your zip code?
(Required.)
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7.
How will you attend the event? (check one)
(Required.)
In-person
Virtually (online)
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8.
How did you hear about the Men's Health Summit event?
(Required.)
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9.
Would you participate in the
FREE
prostate cancer screening at the Men's Health Summit event?
(Required.)
Yes
No
Not sure
Other (please specify)
*
10.
Would you like to be added to the list for future men's health events? (check one)
(Required.)
Yes
No
*
11.
What topic or health condition do you want more information about?
(Required.)
Thank you for registering!
If you plan to attend virtually, a link will be emailed to you. We look forward to seeing you there!
Community Health Equity & Inclusion Team
Tarrant County Public Health
phchei@tarrantcountytx.gov
817-321-5930
