INclued Youth Workshop

1

What's your name?* This field is required.You can use the name you go by, or prefer.

First Name

Last Name

2

What are your gender pronouns, if you're comfortable sharing?Pronouns are how other people refer to you instead of your name. For example: "She threw the ball," or "they went to the store." Some people use one set of pronouns, like they/them. Others use multiple pronouns, like she/he/they.

3

What is your email address?* This field is required.We will only use your email to send you stuff about INclued.

example@example.com

4

And what is your phone number?We will only use your phone number to text you updates about the INclued workshop. This is optional. By entering your phone number, you have given us permission to contact you about the INclued workshop you've registered for.

Please enter a valid phone number.

5

What is your age?* This field is required.

6

Great! Which workshop would you like to attend?* This field is required.Ages 12 - 17

Let me know about future workshops!

7

Great! Which workshop would you like to attend?* This field is required.Ages 18 - 19

Saturday, 9/28 1:00 PM -4:00 PM @ WMU Trimpe Building (In-Person!)

Let me know about future workshops!

8

Great! Which workshop would you like to attend?* This field is required.Ages 20 - 24

Saturday, 9/28 1:00 PM -4:00 PM @ WMU Trimpe Building (In-Person!)

Let me know about future workshops!

9

If we need to contact an adult in case of an emergency while you are attending the workshop, who should we contact and how are they related to you? * This field is required.This person must be over the age of 18.

10

What is your emergency contact's phone number?

Please enter a valid phone number.

11

Do you have any access needs or disability accommodations that you would like us to know about?

12

Would you like to be signed up to receive updates from Planned Parenthood about health care services and events happening in Michigan?* This field is required.

Yes, please!No, thanks.

13

Please verify that you are human* This field is required.