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OAD Week of Events Registration Form

Event Interest Form for Attendees

Join us for a week of events dedicated to raising awareness, honoring lives lost to overdose, supporting the bereaved, and promoting collective action against overdose.

Coordinated by a committee of various agencies, August 26 - August 30 will feature community Naloxone trainings, an event featuring speakers to gain insights into recovery and ways to support those affected, a remembrance walk, and so much more.

1. Please provide your name below. *This question is required.

2. Please provide your email below. *This question is required. This question requires a valid email address.

3. Which Overdose Awareness Day event are you interested in attending? You will be contacted with additional details as the event approaches. *This question is required.

August 26 - Naloxone Training at Anthem Community Wellness Center
August 27 - OAD No Stigma No Shame
August 28 - Flowerpot Painting Night with RSIC
August 29 - OAD Walk - Stepping Towards Resilience
August 30 - Naloxone Training with New Dawn Treatment Center
August 30 - Recovery Olympics with Reps4Recovery

4. If you are attending the Naloxone Training on August 26th, please provide your email below. This question requires a valid email address.

4. If you are attending the Naloxone Training on August 30th, please provide your email below. This question requires a valid email address.

4. What category best describes you? *This question is required.

American Indian or Alaskan Native
Asian
Black or African American
Middle Eastern or North African
Native Hawaiian or other Pacific Islander
White
Multiethnic
Prefer not to disclose
Other - Write In (Required) Please enter an 'other' value for this selection. * This question is required.

5. What is your gender? Please select all that apply. *This question is required.

Please enter an 'other' value for this selection.

6. What is your age group? *This question is required.

7. Will you be bringing additional guests to the selected events? If so, how many?

Please enter an 'other' value for this selection.

8. Are you interested in volunteering at an Overdose Awareness Day event? *This question is required.

9. If you answered yes to the previous question, please provide your name, email, and phone number below.

9. Would you be interested in receiving the JTNN monthly newsletter? *This question is required.