Wait List for Bystander Intervention: From Research to Practice

Thank you for your interest in attending our web conference, Bystander Intervention: From Research to Practice. Please fill out the below survey to be added to the wait list. We will invite people from the wait list to register as there are seats available.

The web conference will be recorded and we will email you with a link to view as soon as it becomes available. Additional web conferences will be offered soon -- we hope to connect with you then! Questions? Contact us at info@preventconnect.org.

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* 1. First Name

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* 2. Last Name

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* 3. Email Address

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* 4. Title

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* 5. Agency/Organization Name

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* 6. Are you representing a state health department who receives RPE funds, or a state coalition who receives DELTA funds from the Centers for Disease Control and Prevention?

Yes, representing a state health department receiving RPE funds from the Centers for Disease Control and Prevention

Yes, representing a state coalition receiving DELTA funds from the Centers for Disease Control and Prevention

Unsure

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* 7. All who are registered for this web conference will automatically be added to our mailing list. If you do not wish to be added to our mailing list, please type "no" in the box below.