1. Registration Form

Welcome to the first annual Long Island World Trade Center Responder Family Picnic.

Please fill out this registration form to help us prepare for this exciting event.

* 1. First Name:

* 2. Last Name:

* 3. Occupation/Role during your response to 9/11

* 6. If you have children, please select all the activities that you would like to see at the picnic. (You may select multiple answers)

* 7. Please select all activities that YOU would like to see at the picnic. (You may select more than one answer)

* 8. Please provide us with your email so we can update you about the picnic.

* 9. Since we anticipate a large number of people at the picnic, and because there will be children at the event, please supply us with an emergency contact and their number for the day of the picnic (August 29).