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2016 Fairfield Easton Medical Reserve Corps Annual Education Session Registration

The Fairfield Easton Medical Reserve Corps is hosting its Annual Education Session (AES) at the Bigelow Center for Senior Activities (formerly Fairfield Senior Center, 100 Mona Terrace, Fairfield, CT 06824) on Thursday June 2, 2016 from 5:30-7:30pm.  The theme of this year's AES is Emerging Infections and Zika Virus. 
1.Will you be attending this event?(Required.)
2.Please fill out your contact information below.
3.Who are you representing?
4.I will be signing up for the Zika Prevention Campaign and go door to door placing mosquito borne illness prevention door hangers on homes.
5.If yes to Question 4, I am willing to distribute door hangers to approximately the following number of homes: