Community Conversations Marquette Registration

The Community Conversation will take place on Tuesday, April 21, 2015 from 9:30 a.m. to 2:00 p.m. at the Masonic Temple in Marquette, Michigan. For more information please contact Nicki Bush at 906-228-5744 or nicki@upsail.com

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* 1. Please fill out the information below

Name

Direct Care Worker Name (if they are coming with you)

Organization

Address

Phone

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* 2. If you would like to be added to the DD Council's mailing list please check "yes" below.

Yes

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* 3. Choose three (3) topics that are a priority to you (if there is a topic not listed that is a priority to you, please fill it in under other).

Self-Advocacy (speaking up for yourself)

Employment (working in the community)

Community Inclusion (being a part of your community)

Housing (living where you want)

Transportation (getting where you want to go)

Self-Determination (directing your life)

Other

Other (please specify)

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* 4. Please list any accommodations you need to fully participate.

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* 5. Please list any dietary restrictions.

Vegetarian

Vegan

Gluten Free

Other