Community Listening Sessions - Bend, OR

"Taking Charge of My Healthcare" Party and Community Listening Session in Bend, OR.

Thank you for attending one or more of our events at Abilitree, in Bend, OR on April 8th & 9th, 2019. Please note the space is limited for both events. This form will allow you to register for:

1. "Taking Charge of My Healthcare" Launch and Pizza Party, Monday April 8th, 4:30pm -7:00pm.

2. Bend Community Listening Session, Tuesday April 9th, 11:30am -4:30pm

You can register for one or both of these events on this form.

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* 1. Name

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* 2. Please select one of the following categories that best describes you and/or your role. If not listed here, please select "Other" and fill in the name of your position.

Case Manager, Service Coordinator, or Personal Agent

Employment Professional

"Front Line" Professional (Foster Care Provider, Direct Support Provider, Personal Support Worker)

Agency/ Company Management

Self-advocate/Community Member

Parent or family member of person with I/DD

Other (please specify)

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* 3. City

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* 4. E-mail Address

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* 5. Phone Number

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* 6. If you have any accommodation needs to participate in any of the events please list them below.
Accommodations requested after March 29th are not guaranteed.

Question Title

* 1. Name

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* 2. Please select one of the following categories that best describes you and/or your role. If not listed here, please select "Other" and fill in the name of your position.

Question Title

* 3. City

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* 4. E-mail Address

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* 5. Phone Number

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* 6. If you have any accommodation needs to participate in any of the events please list them below. Accommodations requested after March 29th are not guaranteed.

* 6. If you have any accommodation needs to participate in any of the events please list them below.
Accommodations requested after March 29th are not guaranteed.