Be Connected Listening Session Sign-Up

Be Connected Listening Session Sign-Up

Thank you for your interest in participating in a listening session. Please submit this form and a member of our team will follow up to confirm your participation and provide location details. Thank you.
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
What location, date & time do you want to attend?*

Phoenix - 12/8 - 1730 - 1900
Please tell us briefly about your military service and your interest in participating in the listening session.*
Refreshments will be provided. Do you have any special dietary needs?
Please let us know any additional information or questions.
Please check to indicate your agreement with the following:
- I am opting to participate in a listening session with the Be Connected program.
- I understand the session will be recorded and the information gathered will be used to help Be Connected better serve the veteran community. My name and personal identifying information will not be used going forward, only my input and feedback.
- I agree to sign a waiver on the day of the listening session.
- I will receive a $35 gift card in acknowledgment of my time at the end of participating in the listening session.
Thank you! A member of our team will be in contact shortly.
Should be Empty: