Iberia Parish Community Preparedness Workshop - Thursday, June 8, 2023

Westgate High School Auditorium

Please answer the following questions to confirm your registration to attend. This information will be used for documentation of those participating in the Iberia Parish Community Preparedness Workshop. Only registered individuals will be receiving a home preparedness kit. Registration is subject to approval.

Location Updated To:

Westgate High School Auditorium

2305 Jefferson Island Rd, New Iberia, LA 70560

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* 1. Name (First and Last)

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* 2. Address

Address

City/Town

State/Province

ZIP/Postal Code

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* 3. Phone Number 1

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* 4. Email Address

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* 5. Please provide your age range (for data collection only)

Under 21

Age 21-44

Age 45-65

Age 65+

Iberia Parish Community Preparedness Workshop - Thursday, June 8, 2023

Westgate High School Auditorium

Question Title

* 1. Name (First and Last)

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* 2. Address

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* 3. Phone Number 1

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* 4. Email Address

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* 5. Please provide your age range (for data collection only)

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* 6. Additional Comments:

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* 7. Please list the number of additional family members attending with you who will not be registered.