Registration NAPH - Health Education/ Awareness Session
NMRC will be conduction health education & awareness sessions for American Indians in the panhandle who want to know about covid19 & flu mitigation. Sessions will be held in Cherry, Sheridan, Dawes and Box Butte Counties. Free PPE and additional incentive will be given to those who participate.
Event Timing: January - June, 2021
Event Address: 332 N Main St. Gordon, NE 69343
Contact us at (308) 221-1203 or
naphas@nmrc-inc.org
Txt keyword "NAPHAS" to (833) 579-0997
Msg & Data rates may apply
PPE Kits will be delivered/handed out during your session. Additional incentive will be delivered/handed out after a short follow-up survey at the end of your session.
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Name
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Contact Phone or Email , (email preferred for online session)
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City
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Valentine NE
Gordon NE
Rushville NE
HaySprings NE
Alliance NE
Chadron NE
Crawford NE
Would you prefer an online virtual session?
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Have you been in contact with anyone who has been exposed or has COVID19?
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I understand that by submitting this form I will reserve my session.
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