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Men and Boys Action Team
Men and Boys Action Team, Campaigns and Engagement | Suicide Prevention Collaborative
Select session/event you would like to register for:
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Blackie's Pasture Hike: Saturday January 11, 2025 9AM
Men and Boys Meeting 1/16 2025 4PM
Men and Boys Meeting 12/12/24
Men and Boys Meeting 11/14/24
Blackie's Pasture: 9/21/24
Name
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First Name
Last Name
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Cell
Email
Email
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ONLY information about this workshop
YES! And also add me to @BHRS community email list to get information about future workshops/events related to mental health and recovery
NO! do not add me to any email list
Phone Number
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Demographic Form (Optional)
The MHSA rules require that we keep track of some basic information to report on who participated in our programs. However, you may decline to answer any of these questions. Your responses are confidential and are not linked with your name, email address, or any other personal identifying information.
If you are a Marin County resident, what zip code do you live in?
Zip Code
What is your race/ethnicity?
Asian
Latino/Hispanic
African or African American/Black
Pacific Islander
American Indian or Alaskan Native
Middle Eastern or North African
White/Caucasian
Multi-Race
Prefer not to answer
Other
What is your age?
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0-15
16-25
26-59
60-74
75+
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What language do you most often speak at home?
English
Spanish
Vietnamese
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Other
What is your gender?
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Male
Female
Transgender
Genderqueer
Questioning or unsure of gender identity
Another gender identity
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What sex were you assigned at birth?
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Female
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What is your sexual orientation?
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Gay or Lesbian
Heterosexual or Straight
Bisexual
Queer
Questioning or unsure of sexual orientation
Another sexual orientation
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Are you a Veteran?
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Yes
No
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Do you have a disability?
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Yes, I am a person with a disability
No disability
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Do you identify as a service provider or community member in a setting that can identify early signs of mental illness? If so, please select your role from the list below:
Please Select
Not Applicable
Community Member
Family Member
Peer Provider
Community Health Advocate/Promotores
Marin County BHRS
Community-based Mental Health and/or Substance Use
Education
Employer
Law Enforcement
Primary Health Care
Emergency Services
Older Adult Centers/Services
LGBTQ+ Services
Transition Age Youth
Native American/Indigenous Community
Social Services (County and Community)
Veterans
Law Practitioners (lawyers, paralegals, mediators)
Faith-Based Organization
Shelters/Homeless
Services/Public Housing
OTHER
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