Appointment Request Form
Let us know how we can help you!
Full Name
First Name
Last Name
Contact Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Preferred method of contact
Please Select
phone
email
text
Zoom
In-person Meeting
Appointment Request Notice
Thank you for submitting an appointment request. We will do our best to accommodate your preferred date and time; however, due to scheduling limitations and our small staff size, we cannot guarantee all requests. Please note that same-day appointment requests cannot be accommodated. Sara Cummins or Teresa Bever will contact you to confirm your appointment details and discuss available options. We appreciate your understanding and patience as we work to meet the needs of everyone we serve.
What date and time work best for you?
How would you prefer to meet?
Phone call
Zoom meeting
In person at the FUSE Office
What resources or programs are you interested in?
Would you like to receive monthly FUSE e-newsletters?
Yes
No
Would you like to receive monthly FUSE texts?
Yes
No
If Yes, select which types of messages you would like to receive.
Direct Services and Skills Trainings (Adaptive Swim, BOSS, Destiny Color Guard, Club CIC, Family Fun Meet Ups, Etc.)
Education and Meetings
Inspiring Abilities Expos (Disability Resource Fairs)
Volunteer Opportunities
Fundraisers
Professional Partnerships (Exhibitor and/or Sponsorship)
Submit
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