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Event Registration: 2025.10.29-30 L2B
Event Information
Event Title:
[webform_submission:node:title]
Event Date:
[webform_submission:node:field_dates:start_date:short]
Your Information
Registration Type
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I am completing this registration for someone else.
I am registering myself.
First Name
Last Name
Email (If registering someone else, please enter their email only.)
Question 1. Please select the HHS Region in which you work
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Region 1
Region 2
Region 3
Region 4
Region 5
Region 6
Region 7
Region 8
Region 9
Region 10
Region 11
I don't know
HHSC staff, trainer, or out of state facilitator
Question 2. Which of the following best describes your role?
Question 2. Which of the following best describes your role?
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Executive Director
CCP Program Director
Coalition Coordinator
PRC Program Director
PRC Data Coordinator
PRC Public Relations Coordinator
PRC Tobacco Coordinator
YP Program Director
Prevention Specialist
Intern/Student/Volunteer
Other…
Question 3. Organization/Agency
This training requires participants to have a copy of the Learning to Breathe Facilitator Manual on hand. Please confirm you have a manual you can use during the training.
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Yes
No
I'm not sure
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