Advocacy class registration September/ October 2024

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Please complete this form in order to attend the advocacy training course

Email *

First Name *

Last Name *

Phone number *

Where do you live? (Country, City, Sate (or province), and Time Zone) *

Will you be in Sunday class or Wednesday class ? *

Sunday (Every Sunday at 2-4pm PDT starting on Sep 29 2024)

Wednesday (Wednesdays at 5-7pm PDT starting Oct 2 2024)

Future Class

Do you have sickle cell (SCD)? *

Yes

SC Trait

Do you work with a Community Based Organization and if so which one? *

Does someone close to you live with SCD? *

Yes

If yes, than what is your relationship with them?

What is your occupation? *

What is your highest level of education? *

What is your ethnicity? *

What is your age? *

Is there anything that would prevent you from being able to participate fully and finish the course?

How did you hear about this class and why did you sign up?

Please let us know if you have any further questions or comments here.

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