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2nd Annual Pause and Play: Registration Form
Participants
Please provide as much information as possible in each section.
1.
Name each participant who will be attending in your group.
First and Last Name:
First and Last Name:
First and Last Name:
First and Last Name:
First and Last Name:
First and Last Name:
First and Last Name:
First and Last Name:
First and Last Name:
First and Last Name:
2.
Have you ever heard of WCSI?
Yes, me or someone I know is currently receiving services through WCSI.
Yes, I have heard about WCSI.
No, but am interested in learning more about the company by attending this event.
3.
How did you hear about this event? (You may pick more than one response)
A Caseworker
Word of Mouth
Social Media
Through a Local Business
Other (please specify)
4.
What are you most looking forward to by attending this event? (You may pick more than one response).
To learn more about community resources pertaining to behavioral and mental health.
An opportunity get out of the house and enjoy fresh air at a park.
An opportunity to communicate with others.
An opportunity to partake in an event within my community.
Other (please specify)
5.
Please list the primary contact information in your group, so that we can keep you up to date with any changes that my take place prior to the event date.
Name
Address
Address 2
City/Town
State/Province
ZIP/Postal Code
Country
Email Address
Phone Number
6.
Would you like to be added to our mailing list to receive information about
future events at WCSI?
Yes
No
7.
Would you like to be added to our mailing list to receive WCSI's quarterly newsletter?
Yes
No
