Take 5: Back to Basics - Event Registration Survey

Registration for Take 5: Back to Basics - An Ohio Youth Services Day of Dialogue is FULL as of 3/23/23. Please complete the registration form to be added to a wait list for the Take 5 event at the Warren-Trumbull County Public Library, Warren Library, Friday, May 5 from 9:30 a.m. - 4:30 p.m. If spots open, wait listed registrants will be notified by Monday, May 1. Thank you.

1.Registration information:(Required.)

Your name:

Your pronouns:

Workplace/Affiliation:

Email Address:

Phone number:

2.The event fee of $25 is payable by cash or check in advance or on site, and will cover your lunch, morning and afternoon refreshments, and materials. Warren-Trumbull County Public Library is graciously handling registration payments for this event. Please select your payment method.(Required.)

Check, paid in advance to Warren-Trumbull County Public Library. You will receive a follow-up email with instructions for mailing your check.

Check, paid on site on Friday, May 5.

Cash, paid on site on Friday, May 5.

3.Lunch will be catered by Cockeye BBQ. Vegetarian, vegan, and gluten free options will be available. Do you have any dietary requirements?

No special requirements

Gluten free

Vegetarian

Vegan

Other (please describe)

4.Take 5 provides 6 hours of CE credit for OLC recertification, and may be applicable for CEUs in other programs. A certificate of attendance is available, on request, to document your participation in Take 5, event content and learning objectives, and contact hours.

Certificates will be distributed at the event to those who select "yes" to this question. Will you want a certificate of attendance?(Required.)

Yes

5.There will be an informal get-together for Take 5 attendees in Warren on Thursday evening, May 4. Would you like to receive details about this meetup?(Required.)

Yes

6.(optional) Questions or comments for the Take 5 planning team?

Please click the "Done" button below to complete your wait list request.