2024 AMP Annual Conference

Please complete this survey to be able to join us for AMP's Annual Conference which will be on June 5th at Grandview University in Des Moines from 10am-3pm.

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* 1. Name

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* 2. Age

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* 3. Phone number

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* 4. Email address

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* 5. Address

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* 6. Emergency contact

Name

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 7. Allergies

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* 8. Do you have an epi-pen? If yes, please bring it.

Yes

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* 9. Do you have any dietary restriction? If so, please specify.

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* 10. Do you need assistance with transportation?

Yes

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* 11. What is your current placement type?

Foster Care

Adopted

Reunited with bio family

Kinship

Shelter

Residential Treatment

Aftercare

Aged out

Other (please specify)

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* 12. Would you like to be added to an email list where you will be notified about resources and when AMP has meetings?

Yes

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* 13. MINOR RELEASE AND WAIVER OF LIABILITY FOR PARTICIPATION IN SPECIAL AMP ACTIVITIES- Cedar Rapids Mini Camp

Please fill out the attached waiver and upload here. If you have already submitted a waiver since July of 2023 then you can skip this question.

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