Fraud and Scam Event Registration
Join the ADRC of Northwest WI and the Veteran Service Offices of both Polk and Burnett counties, along with Jeff Kersten of the Bureau of Consumer Protection in learning about how to protect yourself.
You will receive confirmation when you submit your form. If you believe your submission was not received or if you have questions, please contact 877-485-2373 or kayli.williamson@polkcountywi.gov
Sign in to Google to save your progress. Learn more
First Name *
Last Name *
Phone Number *
Email
Town of Residence *
Age
How did you hear about the event? *
Please Note:
If you think you may need transportation, contact Cheryl at the ADRC as soon as possible. 877-485-2372
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy