Telemedicine Workshop Request
After you complete this request, you will be contacted with further details.  Feel free to reach out to us at contactus@communityheropa.org.  
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Email *
Your First Name *
Your Last Name *
Which county are you located? *
What type of workshop are you interested in? *
Required
Are you signing up yourself or group? *
Your Organization (if applicable)
Your Phone Number
Preferred contact method *
Required
Which month/s are you interested in? *
Required
Additional Information You Wish to Provide
A copy of your responses will be emailed to the address you provided.
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