RSVP for Care Agenda: Expanding LTSS for All Town Halls Question Title * 1. First Name OK Question Title * 2. Last Name OK Question Title * 3. Contact Information Organization ZIP/Postal Code Email Address Phone Number OK Question Title * 4. How did you find out about the Care Campaign: LTSS for All Town Halls? OK Question Title * 5. I am RSVPing to attend the Care Agenda: Expanding LTSS for All Town Hall on: Monday, September 16, 20195:30pm – 7:30pmTemple Beth Hillel12326 Riverside DrValley Village, CA 91607 Thursday, September 19, 20199:45AM - 12PMSan Francisco Public Library, Koret Auditorium 100 Larkin StreetSan Francisco, CA 94102 Wednesday, October 9, 2019 3:15-4:30PM Great Wolf Lodge12681 Harbor Blvd.Garden Grove, CA 92840 All Townhalls Neither but I want to attend one near me OK Question Title * 6. I am RSVPing for Myself (1 RSVP) On behalf of a group (please share the estimate size of your group, including you) OK Question Title * 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. Set up 9am -9:45am Clean up 12pm-12:45pm OK We have a commitment to full access OK Question Title * 8. Do you have any access needs for the Town Hall? Please select any that apply: Captioning Large Print Braille Attendant Support Accessible Materials via email Please specify if not listed above OK Question Title * 9. Do you need childcare? If so, for how many and what age are the children? OK Question Title * 10. Do you need language interpretation? Please specify (ex. Spanish, ASL, Cantonese, etc.) OK Question Title * 11. Please share if you have any food allergies or restrictions OK Question Title * 12. Do you have an LTSS affordability story to share? Yes- I currently struggle, or have struggled, or worry I will struggle, to afford sufficient long term supports and services. Yes- I worry about a loved one who cannot afford the services they need and/or I struggle to support my loved one because of the costs to me such as lost wages, compromised health or other challenges Yes- I am a homecare worker /personal care attendant who isn't able to save for my own long-term services and supports needs. Yes- other, tell us! OK Question Title * 13. Any other questions, comments or concerns: OK For more information or questions: Contact firstname.lastname@example.org for: Monday, September 16, 2019 5:30pm – 7:30pm Temple Beth Hillel 12326 Riverside Dr Valley Village, CA 91607Contact email@example.com for: Thursday, September 19, 20199:45AM - 12PM Koret Auditorium, San Francisco Public Library 100 Larkin Street, SF 94102Contact firstname.lastname@example.org for: Wednesday, October 9, 2019 3:15-4:30PM Great Wolf Lodge12681 Harbor Blvd.Garden Grove, CA 92840 OK THANK YOU!