Balloon Project Registration Form

1

Name* This field is required.

First Name

Last Name

2

E-mail* This field is required.

3

Phone Number* This field is required.

Area Code

Phone Number

4

Postal / Zip Code* This field is required.

5

Which workshop do you plan to attend?* This field is required.

September 24: 10:30am-11:00am

October 8: 10:30am-11:00am

We plan to attend both workshops

6

Enter the number of children in your group who will attend the workshop(s).* This field is required.

7

Enter the number of adults in your group who will attend the workshop(s).* This field is required.

8

Will you need English to Spanish translation services during the workshop(s)?* This field is required.The workshops will be presented in English, but English to Spanish translation services are available. This service must be requested in advance.

YESNO

10

For the people in your group/family who identify as Latino or Hispanic American, please select the ethnicities with which they identify. Please select all that apply.

Mexican, Mexican American, or Chicano

Puerto Rican

Cuban

I prefer not to answer

11

If there is anything else you would like to let us know, please list it below. Thank you!