NW Minn. CoC - January 2019 Youth Collaboration Training Registration (Free). Day 1 (Friday, Jan. 11th in McIntosh) is primarily focused on adults. Day 2, Sat., Jan. 12th in Bemidji, is primarily focused on youth (adults are welcome as observers).

Your First and Last Name:

The name you prefer to be called by:

Your Organization/Tribe/or public agency:

Your Preferred Gender Pronoun(s) (she/her/her, they/them/theirs, he/him/his):

Your Position:

Your Work Phone #:

Your Cell Phone (this is optional but very helpful!):

Your Email

Your Physical Location

Your MAILING Address (Street # & Name only)

Your City

Your Zip Code

Yes

I'm a definite maybe

If you answered "maybe," when will you know?

Yes

I'm a definite Maybe

If you answered "Maybe," when will you know?

Representative #1:

Representative #2:

Representative #3:

Representative #1:

Representative #2:

Representative #3:

	Yes	No
Gluten-Free	Gluten-Free Yes	Gluten-Free No
Vegetarian	Vegetarian Yes	Vegetarian No
Vegan	Vegan Yes	Vegan No
No dairy/No Eggs	No dairy/No Eggs Yes	No dairy/No Eggs No
Other (please explain in comments below)	Other (please explain in comments below) Yes	Other (please explain in comments below) No
I drink Coffee	I drink Coffee Yes	I drink Coffee No
I drink Tea	I drink Tea Yes	I drink Tea No
Water preferred	Water preferred Yes	Water preferred No
Diet Coke Preferred	Diet Coke Preferred Yes	Diet Coke Preferred No
Regular Coke Preferred	Regular Coke Preferred Yes	Regular Coke Preferred No
Sprite Preferred	Sprite Preferred Yes	Sprite Preferred No
Diet Sprite Preferred	Diet Sprite Preferred Yes	Diet Sprite Preferred No

Other (please specify):

	Yes	No
Gluten-Free	Gluten-Free Yes	Gluten-Free No
Vegetarian	Vegetarian Yes	Vegetarian No
Vegan	Vegan Yes	Vegan No
No dairy/No Eggs	No dairy/No Eggs Yes	No dairy/No Eggs No
Other (please explain in comments below)	Other (please explain in comments below) Yes	Other (please explain in comments below) No
I drink Coffee	I drink Coffee Yes	I drink Coffee No
I drink Tea	I drink Tea Yes	I drink Tea No
Water preferred	Water preferred Yes	Water preferred No
Diet Coke Preferred	Diet Coke Preferred Yes	Diet Coke Preferred No
Regular Coke Preferred	Regular Coke Preferred Yes	Regular Coke Preferred No
Sprite Preferred	Sprite Preferred Yes	Sprite Preferred No
Diet Sprite Preferred	Diet Sprite Preferred Yes	Diet Sprite Preferred No

Other (please specify):

Question or Concern #1:

Question or Concern #2:

Question or Concern #3.