Opioid Forum Registration

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Opioid epidemic is a growing problem of prescription drug abuse in the US and it is reaching the Muslim community faster than we thought. This forum will help bring awareness, provide a support network, tackle it's social and spiritual ramifications and the path to recovery.

Email *

First and last name *

Phone number *

How did you hear about the event? *

Are you familiar with the term opioid? *

I have never heard about it

Heard about it but don't know what is it exactly

Have very little knowledge about it

I am very much aware of Opioid and it's impact

Other

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What is number one reason for your interest in attending this forum? *

General knowledge

Opioid impacted me, my family or a close fried

I would like to help my community face this crisis

Other

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What are you hoping to gain by attending this forum? *

Send me a copy of my responses.

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