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Participant Questionnaire

Important Instructions: Please fill out the questionnaire below. After you complete the Questionnaire, you will receive a confirmation email. You will also receive subsequent registration reminder emails to sign up for the next Zoom Call. If you do not see an email from us (admin@letstalklive.org) in your inbox, please check your spam or promotions folder.

1. GenderMaleFemale

2. Age RangeUnder 2121-3031-4546-6061-7980 or above

3. Which of the 5 major regions do you live in?West (AK, CA, CO, HI, ID, MT, NV, OR, UT, WA, & WY)Midwest (IA, IL, IN, KS, MI, MN, MO, ND, NE, OH, SD, & WI)Northeast (CT, MA, MD, ME, NH, NJ, NY, PA, RI, & VT)Southwest (AZ, NM, OK, & TX)Southeast (AL, AR, DC, DE, FL, GA, LA, KY, MS, NC, PR, SC, TN, WV, VA, & VI)If not in the U.S., please share where

4. What ethnicity best describes you?WhiteHispanic or LatinoBlack or African AmericanNative American or American IndianAsian / Pacific IslanderOther