Exit 2024 ABLE Roadshow Event Registration Form Question Title * 1. Name Question Title * 2. How do we reach you? Address * Address 2 City/Town * State/Province * -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code * Email Address * Phone Number * Question Title * 3. Do you have an existing ABLE account? Yes No Question Title * 4. What is your role? Person with a disability Family Member or caregiver Service Provider Educator Other (please specify) Question Title * 5. Which event do you plan to attend? Wichita05/06/2024 - 12pm-1pmWichita Public LibraryRockwell Branch5939 E 9th NWichita, KS Osage City05/07/2024 - 12pm-1pmOsage City LibraryCommunity Room515 Main StOsage City, KS 66523 Marysville05/13/2024 - 12pm-1pmMarysville Public Library1009 Broadway StMarysville, KS 66508 Atchison05/14/2024 - 12pm-1pmAtchison Public Library401 Kansas AveAtchison, KS 66002 Leavenworth05/28/2024 - 12pm-1pmLeavenworth Public LibraryYahn Room417 Spruce StreetLeavenworth, KS 66048 Kansas City05/28/2024 - 7pm-8pmKansas Public LibraryWest Wyandotte Library1737 N 82nd StreetKansas City, KS 66112 Lawrence05/30/2024 - 12pm-1pmLawrence Public Library707 Vermont StreetLawrence, KS 66044 Overland Park05/30/2024 - 6:30pm-7:30pmJohnson County Library - Blue Valley9000 W 151st StreetOverland Park, KS 66221 Paola05/31/2024 - 12pm-1pmPaola Free Library101 E Peoria StPaola, KS 66071 Question Title * 6. Do you have any questions or is there anything in particular you would like to learn more about during this session? Question Title * 7. Do you require any special accommodations? Question Title * 8. Is it alright for one of our staff members to reach out to you in advance of the event to confirm your registration? Yes No Question Title * 9. What is the best way to reach you? Phone Email We are under obligation by our federal grant requirements to ask the following demographic questions: Question Title * 10. What is your gender? Question Title * 11. What is your race or ethnicity? American Indian / Alaska Native Asian Black or African American Hispanic, Latino, or Spanish Origin Native Hawaiian or Other Pacific Islander White/Caucasian Multiracial or Multiethnic I prefer not to say Another race or ethnicity, please describe below Self-describe below: Question Title * 12. What is your geographical profile? Urban Rural I prefer not to answer Submit