Health Education Council : Event Registration : Peers Helping Peers Registration

First Name (Required)

Last Name (Required)

Country

Address Line 1

City

State

Postal Code

Email (Required)

Cell Phone (Required)

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Birthdate

Language

Do you have access to a phone, tablet, laptop or desktop computer that you can use to connect to Zoom?

Are you available every Tuesday and Thursday from 2pm-5pm from 10/29/20 to 1/8/20 (except Thanksgiving & Christmas break)?

Why do you want to join this program? (Required)