1.First Name

2.Last Name

3.Affiliation (list the name of your agency, committee, business, etc.. if applicable)

4.Where will you be attending?

January 29th in Alexandria, MN

January 30th in Moorhead

January 31st via Zoom

5.Do you have any specific requests or require any accommodations?

Glutton Free meal

Vegetarian

An interpreter

Other dietary restrictions

Other (please specify)