2023 WV African American Tobacco Prevention Network Training Registration
1.
October 20th at Tamarack in Beckley, WV. 5 pm Dinner. 6 pm. Motown Performance.
October 21st at the Heart of God Church in Beckley, WV. Training from 830am-4 pm.
1703 S Kanawha St, Beckley, WV 25801.
Will you need a hotel room for October 20th?
Yes
No
Other (specify)
2.
Which category below includes your age?
18-20
21-29
30-39
40-49
50-59
60 or older
3.
Which of the following categories best describes your employment status?
Healthcare
Social Services
Government
Church Employee or Volunteer
College Student
Education
Other (specify)
4.
What is your race?
White
Black or African-American
American Indian or Alaskan Native
Asian
Native Hawaiian or other Pacific Islander
From multiple races
Some other race (please specify)
5.
Which West Virginia Counties do you work in?
Barbour County
Berkeley County
Boone County
Braxton County
Brooke County
Cabell County
Calhoun County
Clay County
Doddridge County
Fayette County
Gilmer County
Grant County
Greenbrier County
Hampshire County
Hancock County
Hardy County
Harrison County
Jackson County
Jefferson County
Kanawha County
Lewis County
Lincoln County
Logan County
Marion County
Marshall County
Mason County
McDowell County
Mercer County
Mineral County
Mingo County
Monongalia County
Monroe County
Morgan County
Nicholas County
Ohio County
Pendleton County
Pleasants County
Pocahontas County
Preston County
Putnam County
Raleigh County
Randolph County
Ritchie County
Roane County
Summers County
Taylor County
Tucker County
Tyler County
Upshur County
Wayne County
Webster County
Wetzel County
Other (please specify)
6.
How many years have you been working in tobacco control activities?
0 years - 5 years
6 years - 10 years
11 years - 15 years
16 years - 20 years
21 years - 25 years
26 years or more
7.
How did you learn about this training?
Postcard Received in the Mail
Social Media Ad
WV Division of Tobacco Prevention
Other (please specify)
8.
Are you a past grantee of the WVAATPN?
Yes
No
Unsure
9.
Tell me one thing that you want to learn from this training.
10.
What is your name and address?
11.
What organization do you represent?
12.
What is your email?
13.
What is your phone number?
14.
Will you be attending In Person or by Zoom?
In Person (Beckley, WV)
Zoom
Current Progress,
0 of 14 answered
