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* 1. First Name

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* 2. Last Name

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* 3. Contact Information

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* 4. How did you find out about the Care Campaign: LTSS for All Town Halls?

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* 5. I am RSVPing to attend the Care Agenda: Expanding LTSS for All Town Hall on:

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* 6. I am RSVPing for

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* 7. For September 19th: Can you help with set up or clean up?  If so, please check which one applies and someone will follow up with you.

We have a commitment to full access

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* 8. Do you have any access needs for the Town Hall? Please select any that apply:

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* 9. Do you need childcare? If so, for how many and what age are the children?

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* 10. Do you need language interpretation? Please specify (ex. Spanish, ASL, Cantonese, etc.) 

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* 11. Please share if you have any food allergies or restrictions

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* 12. Do you have an LTSS affordability story to share?

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* 13. Any other questions, comments or concerns: 

For more information or questions: 

Contact aqui@pwcsc.org for: 
Monday, September 16, 2019
5:30pm – 7:30pm
Temple Beth Hillel
12326 Riverside Dr
Valley Village, CA 91607

Contact lindsay@domesticemployers.org  for: 
Thursday, September 19, 2019
9:45AM - 12PM
Koret Auditorium, San Francisco Public Library
100 Larkin Street, SF 94102

Contact allie@cfilc.org for: 
Wednesday, October 9, 2019
3:15-4:30PM
Great Wolf Lodge
12681 Harbor Blvd.
Garden Grove, CA 92840

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