Menstruation Education Workshop Registration Form
Register to participate in our Menstruation Education Workshop. Please complete all fields to secure your spot.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Age Group
*
Please Select
Under 13
13-17
18-24
25-34
35+
Preferred Workshop Session
*
Please Select
Morning (9:00 AM - 12:00 PM)
Afternoon (1:00 PM - 4:00 PM)
Evening (5:00 PM - 8:00 PM)
Do you have any accessibility or accommodation needs?
What is your prior knowledge about menstruation education?
*
None
Basic understanding
Intermediate
Advanced
What are your learning goals for this workshop?
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
How did you hear about this workshop?
Please Select
School or University
Friend or Family
Social Media
Community Organization
Other
Register
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