SD Supporting Families Community of Practice
Regional Meeting Sturgis Area
When: Wednesday June 12th Time: 5:30-7:30 PM MT
Location: Sturgis Community Center
1401 Lazelle Street, Sturgis, SD 57785

Question Title

* 1. Name

Question Title

* 2. Role in attending

Self-Advocate

Family Member

Family/Professional

Community Partner/Professional

Question Title

* 3. Self-Advocates and Family Members will receive a stipend for attending. Please list your mailing address and email address below:

Question Title

* 4. Which of the following options most closely aligns with your gender?

Woman

Man

Prefer not to answer

Question Title

* 5. What is your race or ethnicity?

Asian

Black or African American

Hispanic or Latino

Middle Eastern or North African

Multiracial or Multiethnic

Native American or Alaska Native

Native Hawaiian or other Pacific Islander

White

Another race or ethnicity, please describe below

Self-describe below:

SD Supporting Families Community of Practice
Regional Meeting Sturgis Area
When: Wednesday June 12th Time: 5:30-7:30 PM MT
Location: Sturgis Community Center
1401 Lazelle Street, Sturgis, SD 57785

Question Title

* 1. Name

Question Title

* 2. Role in attending

Question Title

* 3. Self-Advocates and Family Members will receive a stipend for attending. Please list your mailing address and email address below:

Question Title

* 4. Which of the following options most closely aligns with your gender?

Question Title

* 5. What is your race or ethnicity?

Question Title

* 6. Are there any special accommodations needed?

Question Title

* 7. Email Address

SD Supporting Families Community of Practice Regional Meeting Sturgis AreaWhen: Wednesday June 12th Time: 5:30-7:30 PM MTLocation: Sturgis Community Center1401 Lazelle Street, Sturgis, SD 57785

Question Title

* 1. Name

Question Title

* 2. Role in attending

Question Title

* 3. Self-Advocates and Family Members will receive a stipend for attending. Please list your mailing address and email address below:

Question Title

* 4. Which of the following options most closely aligns with your gender?

Question Title

* 5. What is your race or ethnicity?

Question Title

* 6. Are there any special accommodations needed?

Question Title

* 7. Email Address

SD Supporting Families Community of Practice
Regional Meeting Sturgis Area
When: Wednesday June 12th Time: 5:30-7:30 PM MT
Location: Sturgis Community Center
1401 Lazelle Street, Sturgis, SD 57785