RSVP for Care Agenda: Expanding LTSS for All Town Halls

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* 1. First Name

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* 2. Last Name

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* 3. Contact Information

Organization

ZIP/Postal Code

Email Address

Phone Number

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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:

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

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* 6. I am RSVPing for

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

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* 7. 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

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

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

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

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* 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!

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* 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