CRISIS SERVICES SUMMIT at Berkeley City College - GUEST Registration Form

ALL ARE WELCOME!

Event Details:

Friday, October 10, 2025
9:00 am - 4:00 pm

Berkeley City College

Berkeley, CA

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* Register by Friday, October 3, 2025! *

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* 1. Enter your First and Last Name:

(Example: Jane Smith; John Smith)

First Name

Last Name

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* 2. Enter your Email Address:

(Example: Username@Domain.org)

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* 3. Enter Your Phone Number:

[Example: (925) 444-4444]

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* 4. Are you an Alameda County Employee?

Yes

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* 5. If so, which Alameda County Agency or Department/Division do you work under?

(Example: Office of The Director, JKL Organization)

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* 6. Enter your Title and Organization:

(Example: Assistant Director of Community Relations, JKL Clinic)

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* 7. Are you a parent/caregiver attending this summit?

Yes

Other (please specify)

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* 8. If you are a student attending this summit, please select your age range below:

14 & Under

15 to 24

25 +

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* 9. If you are a high school student, please enter your High School below:

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* 10. If you are a college student, please enter your College Institution below:

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* 11. How did you hear about this event?

Alameda County Internal Intranet Platforms

Social Media Platforms / Internet

Event Brite Promotions

Physical Flyers

Through Las Positas Community College

Other (please specify)

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* 12. Will you be needing accommodations for special needs? If so, please specify below:

(Example: Wheelchair Assistance, Vision Impairment Assistance, Hearing Impairment Assistance etc.)

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* 13. Do you have any questions?

(You can also contact the Office of Ethnic Services, directly at: OfficeofEthnicServices@acgov.org)

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* 14. Are there any issues you would like to hear discussed at the summit?

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* 15. This form is for Guest Registration. Will your organization also be tabling at this event?

NO - If not, you're all set! Please select "No" and click the "DONE" button at the bottom to complete this form before exiting!

YES - If so, please select "Yes" and open the CRISIS Summit Vendor Tabling LINK below in a separate browser window, and complete the Vendor/Organization Registration Survey Form in addition to completing this Guest Registration Survey Form.

Please also be sure to click the "DONE" button below to complete this Guest Registration Survey Form before exiting.

Vendor Registration Link:
https://www.surveymonkey.com/r/HR2HF5B

Yes

CRISIS SERVICES SUMMIT at Berkeley City College - GUEST Registration Form

Question Title

* 1. Enter your First and Last Name:(Example: Jane Smith; John Smith)

Question Title

* 2. Enter your Email Address:(Example: Username@Domain.org)

Question Title

* 3. Enter Your Phone Number:[Example: (925) 444-4444]

Question Title

* 4. Are you an Alameda County Employee?

Question Title

* 5. If so, which Alameda County Agency or Department/Division do you work under?(Example: Office of The Director, JKL Organization)

Question Title

* 6. Enter your Title and Organization: (Example: Assistant Director of Community Relations, JKL Clinic)

Question Title

* 7. Are you a parent/caregiver attending this summit?

Question Title

* 8. If you are a student attending this summit, please select your age range below:

Question Title

* 9. If you are a high school student, please enter your High School below:

Question Title

* 10. If you are a college student, please enter your College Institution below:

Question Title

* 11. How did you hear about this event?

Question Title

* 12. Will you be needing accommodations for special needs? If so, please specify below:(Example: Wheelchair Assistance, Vision Impairment Assistance, Hearing Impairment Assistance etc.)

Question Title

* 13. Do you have any questions?(You can also contact the Office of Ethnic Services, directly at: OfficeofEthnicServices@acgov.org)

Question Title

* 14. Are there any issues you would like to hear discussed at the summit?

Question Title

* 1. Enter your First and Last Name:

(Example: Jane Smith; John Smith)

* 2. Enter your Email Address:

(Example: Username@Domain.org)

* 3. Enter Your Phone Number:

[Example: (925) 444-4444]

* 5. If so, which Alameda County Agency or Department/Division do you work under?

(Example: Office of The Director, JKL Organization)

* 6. Enter your Title and Organization:

(Example: Assistant Director of Community Relations, JKL Clinic)

* 12. Will you be needing accommodations for special needs? If so, please specify below:

(Example: Wheelchair Assistance, Vision Impairment Assistance, Hearing Impairment Assistance etc.)

* 13. Do you have any questions?

(You can also contact the Office of Ethnic Services, directly at: OfficeofEthnicServices@acgov.org)