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show submenu for “Take Action”
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show submenu for “Learn 3 Steps Detect”
Step 1: Know Your Great
Step 2: Use the 2-Week Rule
Step 3: Share with Your Doctor
Your Job as a Patient
Know Your Family History
Learn from Others
Education & Training
show submenu for “Education & Training”
First Responder Training
show submenu for “First Responder Training”
First Responder Resources
Health and Well-Being Program
Community Education
Young Adult Education
show submenu for “Young Adult Education”
Michael Bodge Tribute Fund
Get Involved
show submenu for “Get Involved”
Share Your Story
Ways to Give
show submenu for “Ways to Give”
Response Time Matters Campaign
Charity Athletes
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Young Adult Education: Request a Program
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Young Adult Education: Request a Program
Program Request
Name
*
First
Last
Email
*
Phone
Preferred Method of Contact
Email
Phone
Organization Name
*
Organization Location
City
Alabama
Alaska
Arizona
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Delaware
District of Columbia
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Armed Forces Americas
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State
What is Your Job Title/Role?
Organization Type
Fire Department / First Responder
High School / College / University
Corporate / Workplace
Community / Other
What type(s) of program(s) are you interested in?
On-site presentation(s) (recommended for within New England, can be scheduled for Union Meeting or multiple shift days)
Live Webinar (facilitated via Zoom or platform of your choice)
What type(s) of program(s) are you interested in?
Virtual “Guest Speaker” from DetecTogether - via Zoom or platform of your choice
Train-the-Trainer for yourself and/or other teachers
Student-led online education
Do your students have internet-accessible devices at home (computer, laptop, tablet, etc)?
Yes
No
Unsure
Are you and/or your students familiar with Google Slides?
Yes
No
Unsure
What type(s) of program(s) are you interested in?
Live on-site presentation (recommended for groups of 20+ attendees, within New England)
Webinar / Digital Lunch & Learn (recommended for 10-300 attendees, and/or multiple sites)
When is the best time for a program?
ASAP
Within 1-2 months
3-6 months from now
6+ months from now
Unsure
Comments / Questions?
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