RSVP for Care Agenda: Expanding  LTSS for All Town Halls Survey

1.First Name(Required.)

2.Last Name(Required.)

3.Contact Information(Required.)

Organization

ZIP/Postal Code

Email Address

Phone Number

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

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

Monday, September 16, 2019
5:30pm – 7:30pm
Temple Beth Hillel
12326 Riverside Dr
Valley Village, CA 91607

Thursday, September 19, 2019
9:45AM - 12PM
San Francisco Public Library, Koret Auditorium
100 Larkin Street
San Francisco, CA 94102

Wednesday, October 9, 2019
3:15-4:30PM
Great Wolf Lodge
12681 Harbor Blvd.
Garden Grove, CA 92840

All Townhalls

None but I want to attend one near me

6.I am RSVPing for(Required.)

Myself (1 RSVP)

On behalf of a group (please share the estimate size of your group, including you)

We have a commitment to full access

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

Please specify if not listed above

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

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

10.Please share if you have any food allergies or restrictions

11.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!

12.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

Current Progress,

0 of 12 answered