2019 Conference for Parents of Children who are Deaf, Hard of Hearing, or Deaf-Blind Survey

1.Please enter information below to register:

Last Name

First Name

Phone Number

Email Address

3.Are you (check all that apply):

Parent of a child who is deaf, hard of hearing, or deaf-blind

Department of Health Staff

Other (please specify)

4.Lunch Choice (choose one):

Sandwich (not vegetarian)

Salad (vegetarian)

5.Do you have any food allergies?

No

Yes

If yes, please explain:

6.Are there any special accommodations we need to be aware of?

No

Yes

If yes, please explain:

2019 Conference for Parents of Children who are Deaf, Hard of Hearing, or Deaf-Blind