2023 SPRING COMMUNITY CONFERENCE REGISTRATION FORM

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Thank you for your interest in attending Safe Streets' 2023 Community Conference. Please complete the following form to register for the event. The event will be held on May 12, 2023 at Stewart Middle School.

Email *

First Name *

Enter the first name of the primary registrant. Please do not list more than one individual

Last Name *

Enter the last name of the primary registrant. Please do not list more than one individual

Phone Number

Enter the preferred primary phone number of the registrant. Please include area code

Zip Code *

Special Assistance for Registrant

Safe Streets is committed to making this event accessible. Please indicate any special assistance needs for the registrant, and we will do our best to provide such assistance. Please note that this we may contact you with additional questions based on your response below. PLEASE NOTE: Safe Streets may not be able to honor every request for special assistance, but will work with you to make the conference as accessible as possible.

None

Other:

If you have any other dietary needs, please select other and provide details.
*

No dietary restrictions

Vegetarian

I do not want a meal

Thank you for your interest in the Spring Conference. If you have any questions or need additional information, please feel free to contact Safe Streets at: frontdesk@safest.org or call: 253-272-6824.

This is the end of the registration form and we look forward to seeing you on May 12.

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