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Embrace Digital Summer Summit
Detailed Registration Form for the Summer Summit: July 24 & 25, 2020
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Attendee Name
*
Your answer
Attendee Birthdate
*
Your answer
Name of Primary Contact (If different than attendee)
Your answer
Email
*
Your answer
Is there anything we should be aware of to support the attendee's access needs?
Your answer
Emergency Contact Name & Phone Number
*
Your answer
Pictures and/or video may be taken during the this event. These photos may be posted on social media and/or used for advertising purposes.
*
Yes, I give my permission
No, I do not give my permission
As the attendee is working out of their own space, they are responsible to attend to their own health and safety needs.
*
Yes, I understand
Required
What kinds of activities is the participant most interested in? (Check all that apply)
Dance
Music
Social Time
Other:
I'd like to be on Embrace's mailing list to learn more about free community events, classes, etc.
Yes, please!
No thank you.
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