Reservations for Virtual DMF Talk
RequiredRequired Question(s)

Use this survey to register for the Virtual DMF Talk event "CHECK UP ON COVID 19:
A Light at the End of the Tunnel"
via Zoom, Tuesday
, January 12, 2021 beginning at 6:30pm.

 
Advance reservations are required. Registered guests will receive an access link approximately one hour before the event.
 
Required

Only one reservation per household is required. Please enter the information indicated below.


In the "Address 1" box, please put your street address.

In the "Email Address" box, please list the email address where you want the Zoom link sent.


First Name:
Last Name:
Email Address:
emailaddress@xyz.com
Address 1:
City:
Postal Code:

Please list any other individuals from the household that will be joining. (Optional)

 

350 characters left.

Would you like to leave a comment? (Optional)

 

350 characters left.

When you have completed the survey, click the "Finish" button.   You will see a page confirming that your registration survey has been successfully submitted.