Civic Innovation & Engagement: Rising to the Challenges to Our Democracy - Attendee Registration

Saturday, March 25, 2023 from 11:45 am - 4:30 pm at the Chrysalis Center in Hartford, Connecticut.
Please register so that we know who is participating. We will not share your information outside of Everyday Democracy. You may receive emails from Everyday Democracy with information or a satisfaction survey.

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* 1. Name

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* 2. Email

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* 3. Zipcode

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* 4. Are you attending as:

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* 5. Will you require English to Spanish translation services?

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* 6. Will you require any accommodations in order to participate (wheelchair access, ASL interpretation, assistive listening, etc..)?

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* 7. Do you have any dietary restrictions we should be aware of?

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* 8. Race/Ethnicity - Check all that apply.

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* 9. Gender - Check all that apply

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* 10. Age

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* 11. I would like to receive more information about Everyday Democracy and the Connecticut Civic Ambassador program. 

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