InROC Interest Form

The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

H785b6e2QrmXh2QBHdgXhByFeVITCgXDkWVx2sE9I6NL8iVsjGFopn68eW6tYGc3zMeDfTqm7btAY2QGFtT2caMz7hxDvVpGQuUwZda

Thank you for your interest in the Indiana Rural Opiod Consortium (InROC) Peer Mentorship ECHO hosted by the IU Indianapolis ECHO Center. Please complete the interest form below!

For additional questions, please contact Director Andrea Janota at ajanota@iu.edu.

Thank you!

This survey is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $2,349,984 with 0% percentage financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov.

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