Chapter Participation Form Name* First Last Email* Enter Email Confirm Email Your Zip Code* ZIP Code 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?*Under 1818-2425-3435-4445-5455-6465 or AbovePrefer Not to AnswerWhat 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?*-- SELECT A CHAPTER --YPR - Adams County, COYPR - Allegheny County, PAYPR - Amherst, MAYPR - Antelope Valley, CAYPR - Arapahoe County, COYPR - Arvada Spanish, COYPR - Atlanta, GAYPR - Augusta, MEYPR - Baltimore, MDYPR - Berkeley, CAYPR - Berkshire County, MAYPR - Bozeman, MTYPR - Brewer, MEYPR - Canon City, COYPR - Cape Cod, MAYPR - Chico, CAYPR - Cincinnati, OHYPR - Cleveland, OHYPR - Colorado Springs, COYPR - Columbus, OHYPR - Cortez, COYPR - Danville, KYYPR - Defiance, OHYPR - Denver, COYPR - Denver Spanish, COYPR - Dorchester, MAYPR - Draper, UTYPR - Durango, COYPR - Fort Collins, COYPR - Fresno, CAYPR - Grayson, KYYPR - Greensboro, NCYPR - Harrodsburg, KYYPR - Houston, TXYPR - Huntsville, ALYPR - Inland Empire, CAYPR - Jackson, MSYPR - Jefferson County, COYPR - Las Vegas, NVYPR - Lewiston, MEYPR - Lexington, KYYPR - London, KYYPR - Lorain County, OHYPR - Los Angeles, CAYPR - Louisville, KYYPR - Lowell Lawrence, MAYPR - Merced, CAYPR - Modesto, CAYPR - Monterey, CAYPR - Morehead, KYYPR - Nashville, TNYPR - NationalYPR - New York City, NYYPR - Nicholasville, KYYPR - Olympia, WAYPR - Orange County A, CAYPR - Orem, UTYPR - Paducah, KYYPR - Palm Desert, CAYPR - Pikeville, KYYPR - Portland, MEYPR - Pueblo, COYPR - Redding, CAYPR - Richmond, KYYPR - Richmond, VAYPR - Sacramento, CAYPR - Salt Lake City, UTYPR - San Bernardino, CAYPR - San Diego, CAYPR - San Francisco, CAYPR - Santa Barbara, CAYPR - Somerset, KYYPR - South Bend, INYPR - South East Tx, TXYPR - Springfield, KYYPR - Springfield, MAYPR - Test, JWYPR - Thornton Spanish, COYPR - Toledo, OHYPR - Tooele, UTYPR - Vicksburg, MSYPR - Walla Walla, WAYPR - Winchester, KYYPR - Woburn, MAYPR - Worcester, MAPlease enter a chapter name above!What type of event did you attend?* All Recovery Meeting Education Workshop Housing Workshop Employment Workshop Financial Literacy Workshop Recovery Messaging Workshop Leadership Meeting/Business Meeting/Planning meeting Pro-social Event Advocacy Workshop History of the Opioid Crisis Presentation YPR Overview Workshop Advocacy Event Date of Event* MM slash DD slash YYYY Future EmailsWould you like to receive future emails from YPR?*YesNo