Getting Started as an ACP HOST: 5-Minute Questionnaire

Make a Difference in Your Community

Complete this brief questionnaire, and a Heart Tones team member will contact you to answer your questions and schedule your ACP workshop. 

Why This Matters: The Let's Talk About ACP workshop empowers African Americans to document their healthcare wishes and make informed decisions about end-of-life and emergency care. As a host of the workshop,  you'll help individuals and families navigate these critical conversations with confidence and clarity.

What You'll Receive: Your $395 workshop registration includes:

  • Complete ACP presentation
  • Workshop materials
  • Supportive services from our team

Ready to Get Started? Join our community of workshop hosts who are creating meaningful change, one conversation at a time.

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Email *
Your Full Name: *
Your Organization or Church Name *
Will you be the main contact person for coordinating the Workshop? *
If not, please list the primary contact's information below including their name, e-mail, and phone number. (Put "N/A" if you are the primary contact) *
Your Cell Number: *
Can we contact you through text message? *
Your Mailing Address (include City, State, and Zip): *
How did you hear about the Let's Talk About ACP Facilitator Training and Workshops? *

On a scale of 1 - 10, how familiar are you with African American cultural perspectives and community needs?

 *
Will you be hosting virtually or In-Person? *
On a scale of 0-10, please rate your level of experience or knowledge using digital technology, such as Zoom web conferencing, event registration websites, social media, email, and online courses. *
No experience or knowledge at all
Expert use / Part of your usual operating activity
How soon are you looking to host a Workshop? *
What payment method works best for you to submit your $395 Workshop fee? *
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