Elephant in the Room Registration

Please complete the registration form to reserve your space at the Elephant In the Room: A Community Conversation on Substance Use. If you have any questions about the event, please contact stycosi@bhsj.org. Event registration will end Thursday, October 9th, at 4 pm. This is a free event open to the community, and registration for continuing education credits is not required.

1. Name: *This question is required.

2. Phone Number *This question is required.

3. Email: *This question is required.

4. Please select an option for your lunch *This question is required.

5. If seeking continuing education credits, select which type:

6. If you are requesting continuing education credits, please provide your ID or license number.