Alumni Contact Info

Full Name
Email Address*
example@example.com
Phone
Street Address
City
State
Zip
If you live in New York State, what County do you live in?
What year(s) were you involved in the O+ Festival?*
What is your connection to the O+ Festival?*

ArtistMusicianWriterDancerComedianHealthcare PractitionerWellness PractitionerVolunteerStaffProgram Attendee
Do you currently have health insurance? (your insurance status does not impact your access to the O+ Exchange clinic or Festival Clinic)

YesNoSort of
If you answered "Sort of" - please explain!
What kind of healthcare do you have?

PrivateMedicaid/MedicareEmployer (self or spouse/partner)State exchange program (Obamacare)O+ Exchange
How did you first hear about the O+ Festival?

AdvertisingWord of mouthRadioPrintO+ WebsiteOther
If Other - please explain
Are there any health/wellness services you are most interested in accessing or learning about?
Self-identity section
Please only answer these questions if you are comfortable doing so! As with all the questions on this form, we are asking for this demographic information specifically for grant writing/reporting purposes.
Age
Gender
Sexual Orientation
Race
What is your income per year?

$0-$20,000$20,000-$50,000$50,000-$75,000$75,000+
Should be Empty: