Mindful Decomissioning Accommodation Survey

Register

Great! We are excited to see you on Zoom on October 2, 2024 from 6-8 pm. Please register by completing the information below.

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* 1. Please complete the information below to register for the workshop

Name

Email

Zip code

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* 2. How will you participate in the workshop?

From my computer

From my phone

Another way

Other (please specify)

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* 3. Will you need interpretation services in the workshop? If so, which language(s)?

No

Yes, please specify what language you need interpretation in:

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* 4. Will you need translation of the outreach materials? If so, which language(s)?

No

Yes, I will need translation materials in ____ language.

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* 5. Will you require materials to be accessible for disability needs? If so, please describe the need.

No

Yes, please describe how we can support you.

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* 6. Would you prefer the workshop to include closed captioning?

Yes

No

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* 7. What additional accommodations will you require to actively and meaningfully participate in the workshop?

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* 8. Are you affiliated with a community-based organization?

No

Yes, please speficy: