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Finger Lakes Deaf Health Fair 2023 - Event Registration
Event Date: Saturday, September 30, 2023
Event Time: 10:00 AM to 3:00 PM
Event Location: Rochester Museum & Science Center
Event Address: 657 East Ave, Rochester, NY 14607
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Background Information
First Name
*
Your answer
Last Name
*
Your answer
Email Address
*
Your answer
Zip Code (ASL Version)
Zip Code (Your Residential Address)
*
Your answer
Demographic Information
Gender (ASL Version)
Gender
*
Male
Female
Transgender
Non-Binary (Not identify as male and female)
Prefer not to say
What is your age?
*
Under 18 years old
18 - 28
29 - 39
40 - 49
50 years or above
Which are you?
*
D/deaf
Deaf-Blind (Support Service Provider is provided)
Hard of Hearing
CODA (Child of Deaf Adults)
Hearing
Your Race/Ethnicity (ASL Version)
What is your race/ethnicity?
*
Hispanic or Latino
White (Non-Hispanic or Non-Latino)
Black or African American
Asian
Native Hawaiian or Other Pacific Islander
American Native/Indigenous or Alaska Native
Two or More Mixed Races
Other:
Language Question (ASL Version)
Which language do you typically use the most?
*
American Sign Language (ASL)
Spoken Language
Other:
Event Information
Event Question 1 (ASL Version)
Have you been to this event before?
*
Yes
No
Event Question 2 (ASL Version)
How did you find out about this event?
*
Your answer
Event Question 3 (ASL Version)
Do you need an accommodation for this event?
Yes
No
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