2022 CHA Survey Training Registration Form

CHA Survey Training Registration

Training Registration Form
This training registration form is to help the Durham County Department of Public Health 2022 Community Health Assessment team to better prepare you for going door to door. The answers to these questions will help us better present the training to you. This training will last for three hours, and you are required to attend the entire training. Masks and COVID-19 vaccinations are required. Refreshments will be served.

For further questions, or if you do not get a confirmation email after registration, please contact

Savannah Carrico

Durham County Public Health
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Type of Phone Number (Above)

Work PhoneHome PhoneCell Phone
Email
example@example.com
Food Allergies
Please Select which of the following dates that you will be able to attend the CHA training:
Friday, September 16, 10am - 1pm (Press the 10 AM Button to Select)
Monday, September 19, 10am - 1pm (Press the 10:00 AM Button to Select)
Monday, September 19, 2pm - 5pm (Press the 10:00 AM Button to Select)
Monday, September 26, 10am - 1pm (Press the 10:00 AM Button to Select)
Monday, October 3, 2pm - 5pm (Press the 2:00 PM Button to Select)
Monday, October 10, 10am - 1pm (Press the 10:00 AM Button to Select)
Monday, October 17, 10am - 1pm (Press the 10:00 AM Button to Select)
Should be Empty: