Shelter Training - LA State Citizens Corp Council -June 4, 2022

Shelter Training, available In-Person and Virtual (online)

Please answer the following questions to confirm your enrollment to attend. This information will be used for documentation of those participating in the training. Registration is subject to approval.

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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

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* 4. Email Address

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* 5. Group/Organization Name:

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

Under 21

Age 21-44

Age 45-65

Age 65+

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* 7. Indicate if you will attend In-Person or Virtual (online):

In-Person (Live)

Virtual (Online)

Shelter Training - LA State Citizens Corp Council -June 4, 2022

Shelter Training, available In-Person and Virtual (online)

Question Title

* 1. Name (First and Last)

Question Title

* 2. Address

Question Title

* 3. Phone Number

Question Title

* 4. Email Address

Question Title

* 5. Group/Organization Name:

Question Title

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

Question Title

* 7. Indicate if you will attend In-Person or Virtual (online):

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* 8. Do you have any food allergies or dietary restrictions? Explain...

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* 9. Additional Comments: