Healthiest Manitowoc County | QPR Registration

Please fill out the required fields in this form to be registered for a free QPR- Question, Persuade, Refer training. Demographic questions at the end are optional and allow the Zero Suicide Taskforce to monitor areas that may have gaps in representation. Individual demographic information will not be shared with the public.

QPR Registration Form

Pick a class from the options below. Note: If you do not see a class in the options that was previously advertised, the class is FULL and was removed. *

First Name *

Last Name *

Email Address *

Phone Number *

Organization Affiliation (if none, please put community member) *

Gender

Age

Ethnicity

Race

Are you a Veteran?

Yes

What city/town do you currently live in?