Take Back Event Spring 2023: Registration to partner with OPEN

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Opioid Prescribing Engagement Network (OPEN) is helping sites across Michigan plan DEA Drug Take Back Events. Please complete this form to help OPEN track the effectiveness of these events for our communities. This form is required for anyone who wishes to have their Take Back Event advertised on OPEN's website, receive reimbursement from OPEN, and report their medication collection numbers to OPEN.

If you have any questions, please contact Chelsea Graham at chelsegr@med.umich.edu or visit our website at https://michigan-open.org/. Thank you!

Organization Name *

Contact Name *

Contact Email Address *

Contact Phone Number *

Please select one of the statements below: *

I am confirming that my site will participate in the Spring 2023 DEA Drug Take Back Event.

My site cannot participate in the Spring 2023 DEA Drug Take Back Event.

I am interested in learning more, not confirmed participation yet

Other:

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