From the Mailroom to the Boardroom: YOUR ROLE IN BUILDING A NEUROINCLUSIVE WORKPLACE
Hosted by NEXT for AUTISM and the Ramesh and Kalpana Bhatia Family Foundation at UCLA
RSVP Form
Thank you for your interest in joining us on September 12th! Please take a moment to fill out the contact information below to confirm your in-attendance. (Note: This panel will not be live-streamed. A video of the panel will be shared after the event)
Name
*
First Name
Last Name
Please confirm below:
*
Yes, I'm attending
Sorry, I cannot attend
Email
*
example@example.com - *will not be public
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Phone Type
*
Please Select
Cell
Home
Business
Job Title
*
Company
*
Please select one of the below:
*
I'll be attending solo
I'd like to bring a guest (or a few) and will share this form with them
Accommodations
We strive to host inclusive, accessible events that enable all individuals, including individuals with disabilities, to engage fully.
Please confirm if you'd like someone from our team to reach out about accommodations.
Yes, please contact me at your earliest convienance.
No, I do not need accommodations.
If there is any more information that you'd like to provide on the above (including how you would prefer to be contacted), please include below:
Dietary Restrictions
Refreshments and light bites will be provided. Please let us know if you have any food restrictions or allergies below.
Do you have any food allergies/restrictions?
Yes
No
If yes to the above, please provide more information:
Share a few words...
How did you hear about this event?
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Please share a few words on why this topic is important to you:
If you have a question for our panelists, please share below:
Photo and Video Releases
Please note that the panel event will be recorded and shared with NEXT for AUTISM's network. To help expedite the check-in process on the 12th, you will receive a UCLA video and photo release to your e-mail following your submission (required). Questions? events@nextforautism.org
Please review and confirm the following:
*
I agree to the usage of my image and name in photographs, video, and/or digital media by NEXT for AUTISM from the September 12, 2024 panel
I acknowledge I will be receiving a required video and photo release on behalf of UCLA to the e-mail address provided above
Submit
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