Making Connections Survey

Saturday, May 1, 2010
8:30 am to 2:00 pm
Merritt College
12500 Campus Drive
Oakland, CA 94619

The information regarding organizations and businesses will be compiled into a resource guide. Please be as detailed as possible.

An asterisk ( * ) after the field name indicates it is a required field.

Personal Information

Personal Information First Name *
Last Name *
Title
Organization *
Website

Describe your organization/business’s programs/services/activities.

Address Information

Address Information Street Address *
City *
State *
Zip Code *

Contact Information

Contact Information Work Phone *
Home Phone
Mobile Phone
Email Address *

What issues are you interested in?

What issues are you interested in? Youth Education Faith Health & Human Services Businesses Public Safety	Economic Development Housing Environmental Justice Arts/Culture Media/Technology Civic Engagement
Other (please specify)

Making Connections
Exit this survey

1. Registration

Personal Information

Describe your organization/business’s programs/services/activities.

Address Information

Contact Information

What issues are you interested in?

Making ConnectionsExit this survey

1. Registration

Personal Information

Describe your organization/business’s programs/services/activities.

Address Information

Contact Information

What issues are you interested in?

Making Connections
Exit this survey