Long Island WTC Responder Family Picnic

1. Registration Form

 
Welcome to the first annual Long Island World Trade Center Responder Family Picnic.

Please fill out this registration form to help us prepare for this exciting event.
*
1. First Name:
*
2. Last Name:
*
3. Occupation/Role during your response to 9/11
*
4. How many people will attend the picnic?
*
5. How many of those attending are children?
Number of children
Ages 0-3
Ages 3-7
Ages 7-11
Ages 11+
6. If you have children, please select all the activities that you would like to see at the picnic. (You may select multiple answers)
7. Please select all activities that YOU would like to see at the picnic. (You may select more than one answer)
8. Please provide us with your email so we can update you about the picnic.
9. Since we anticipate a large number of people at the picnic, and because there will be children at the event, please supply us with an emergency contact and their number for the day of the picnic (August 29).
Powered by SurveyMonkey
Check out our sample surveys and create your own now!