Organization:______________________________________________________
Please note if you are a small  Community Group or larger Resource Group

Please fill out separate forms for each individual attending the conference

Name:___________________________________________________________

Phone:___________________________________________________________

Email:___________________________________________________________



Tell us about your group/work in 3-5 sentences.

Will your group need a table for the Monitoring Fair?    Yes        No

If Yes, what monitoring methods and successes will you be showing?

____________________________________________________________________________________________________________________________________________________________

Do you have any dietary restrictions and/or allergies?  If yes, please list: ____________________________________________________________________

 Lunch will be provided, please choose from the following list of sandwiches, sides and drink:

Sandwiches:

Veg________ Turkey_______ Chicken salad___________

Tuna salad_______  Ham _________

Side Dish (pick one):

cut-up fresh fruit_________potato salad____________pasta

salad___________ or chips___________

Drink:

Caffine soda_______Non-caffine soda________Water__________