RFA Event Registration Form

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* 1. Name

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* 2. Phone (optional)

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* 3. Email

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* 4. Company/Organization

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* 5. County

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* 6. What day do you plan on attending the event? (Please pay special attention to the times for Community or Capacity, while you are making your selection.)

CAPACITY- Jan 14th 9:30-12:00 EST-Good Samaritan Hospital, Eva Hill Auditorium, 520 S 7th Street, Vincennes, IN, 47591

COMMUNITY- Jan 14th 1:00-4:00 EST-Good Samaritan Hospital, Eva Hill Auditorium, 520 S 7th Street, Vincennes, IN, 47591

CAPACITY-Jan 15 9:30-12:00 EST-Delaware Township Building, 9094 E 131st Street, Fishers IN 46038

COMMUNITY-Jan 15 1:00-4:00 EST-Delaware Township Building, 9094 E 131st Street, Fishers IN 46038

CAPACITY-Jan 16 9:30-12:00 EST-Plymouth Library, 201 North Center Street, Plymouth, IN 46563

COMMUNITY-Jan 16 12:30-3:30 EST-Plymouth Library, 201 North Center Street, Plymouth, IN 46563