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* Name - as you want it to appear on your name badge:

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* Phone number:

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* Zip code (where you live and/or receive mail):

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* What are your pronouns?

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* I use the following mobility assistance (select all that apply):

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* Affiliation - The organization, group, or city/town you reside in to appear on your name badge and on the attendee list

Accessibility: We aim to host an event that is inclusive and accessible and want your feedback to make sure we don’t miss anything! Please tell us what you need to fully participate in the event. We will follow up on all requests received. If it appears we are unable to meet a specific request, we will work with you to determine whether an alternative arrangement can be made. Please tell us if you want to request any of the following.

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* I request materials in a specific format (select all that apply):

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* I request language access services or communication formats/aids (select all that apply):

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* Are there other accommodations that will help ensure your full participation? (Select all that apply):

Food and Beverage: The summit registration fee covers a mid-morning snack, a box lunch, and beverages throughout the day.

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* Please tell us about your dietary restrictions (select all that apply):

Transportation: Moving Maine is committed to ensuring everyone has a ride to and from the Summit. We will coordinate rides and carpooling - and also have funds to reimburse a limited number of people for their travel costs when that is their preference.

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* Please tell us how you would like to access or offer transportation (select all that apply):

Lodging: Moving Maine has a limited number of hotel rooms available at no cost to people who are travelling great distances and for whom paying for lodging costs would create a barrier to attend the summit. If you would like to access this option, please indicate below.

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* Are you interested in a no-cost hotel room in Bangor for the night of Monday, October 28th? We will contact you regarding details.

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* Is there anything else you would like to tell us that relates to your attendance at the summit?

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* I consent to have my name, affiliation, town/city, and email address included on the attendee list. This list will be shared with all other registrants.

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* Core Values: Please check below to confirm that you have read and agree to honor Moving Maine's Core Values.

Complete Your Registration: Please review and confirm your answers since you will not be able to go back.

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* Complete your registration:

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