Thank you for your interest the Ohio Five workshop "I Have Three Jobs But Just One Brain," a Zoom gathering on Thursday, February 11 from 4:30-6.  Please complete the form below to submit your registration. 

We'll confirm your participation in an email with the Zoom link and any other details before the session.  If we exceed our workshop capacity of 36 participants, we'll create a wait list; those individuals will receive the first option to register for the next gathering of this group. 

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* 1. Your Name

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* 2. Your College

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* 3. Your email address

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* 4. Your position/department (optional)

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* 5. Which caretaking role(s) describes you? (Check all that apply)

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* 6. Of the roles you mentioned above, which is most important for you to discuss in our workshop?

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* 7. Are there topics you'd like to discuss?  Please describe briefly here.

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* 8. What statement best describes what you hope to get out of our gathering?

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* 9. Would you be open to sharing your email address with other registrants in a contact to facilitate networking?

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* 10. Do you need closed captioning for this event?

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