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Chapter Participation Form

Thanks for attending a recent YPR event in your area! We’re glad you came and hope you enjoyed it. So that we can learn more about your experience, can you please take a minute to fill out this form? It will help us improve our events and make them even better!

Name*
First Last
Email*
Enter Email Confirm Email
Have you attended a YPR Chapter event before?*
- Yes
- No
If yes, what event(s)?*
We'd like to learn more about you!
What is your age?*
What term best describes your gender?*
- Female
- Male
- Prefer Not to Answer
What is your race?*
- American Indian or Alaska Native
- Asian
- Black or African American
- Native Hawaiian or other Pacific Islander
- White or Caucasian
- Other
- Prefer Not to Answer
If you selected "Other", please describe below*
What is your ethnicity?*
- Hispanic/Latinx Origin
- Not Hispanic/Latinx
- Prefer Not to Answer
Please Tell Us More About the Event!
What chapter hosted the event?*
What type of event did you attend?*
- Education Workshop
- Housing Workshop
- Employment Workshop
- Finance Workshop
- Recovery Messaging Workshop
- Leadership Meeting/Business Meeting/Planning meeting
- All Recovery Meeting
- Pro Social Activity
- Advocacy Event
Zip Code of Event*
ZIP Code
Date of Event*
Date Format: MM slash DD slash YYYY

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