Helping to Build a Healthier Community

Genesis Horizons Summit

Behavioral Health Learning Events Network Event Submission Form

Event Information
Month: 
Day: 
Year: 
Time of Event:
Name of Event:
Name of Organization Hosting Event:
Location of Event
     Location Name:
     Street Address:
     City:
     State:
Target Audience for Event:
Contact Information for Event Registration
     Contact Name:
     Phone Number:
     E-mail Address:
     Website:
Contact Information for Questions About the Event
     Contact Name:
     Phone Number:
     E-mail Address:
     Website:
 
 
Are Continuing Education credits available?
      Yes      No
Is this event free?
       Yes      No
Is this event organized primarily to educate or raise awareness about an issue related to behavioral health or to facilitate networking among local behavioral health professionals?
      Yes      No
Is this event local and open to the bi-state Quad Cities Community?
      Yes      No
Is the host organization willing to promote this event as part of the QC Hearts and Minds Behavioral Health Learning Events Network?
      Yes      No
Is the host organization willing to complete a post-event survey and return information to the QC Hearts and Minds team?
      Yes      No