Southcoast Massachusetts Summit on Opioid Awareness

Save Our Seats!
Southcoast Massachusetts Youth Summit on Opioid Awareness
Xfinity Center
885 South Main Street
Mansfield, MA
Tuesday, June 2, 2020

To reserve seats for your school/organization, please complete the form below.

THIS IS A SCHOOL BASED EVENT. INDIVIDUAL TICKET REQUESTS WILL NOT BE CONSIDERED. Please indicate the number of students and teachers/chaperones that will be attending the Summit. It is important to provide accurate numbers as each attendee will need a ticket to enter the theater.

Please indicate the number of students and teachers/chaperones that will be attending the Summit. It is important to provide accurate numbers as we will be mailing your parking information and tickets to you.

School/Organization Contact Person Name:*

School/Organization Name:*

School/Organization Address 1:

School/Organization Address 2:

City/Town:

State:

Zip Code:

Email Address:*

Phone Number

Area CodePhone Number

How many members of your school/organization would you like to reserve space for?

Number of Teachers/Chaperones/Adults Attending:*

Number of Students Attending:*

Total Number of Attendees Planning on Attending:*

Do any of your students or chaperones require special accommodations, i.e., wheelchair access, sign language interpreters?*

NoOther

What type of accommodations does your school require?

Hearing Impaired/ASL InterpreterWheelchair AccessVisually ImpairedOther

How many students require ASL Interpretation?

How many students/teachers require wheelchair access?

How many students/teachers are visually impaired?

What form of transportation will you be using to attend the event?*

CarBusPublic TransportationOther

Will you require parking at the event?*

YesNo

How many cars/buses will you require parking for?

Will you need to leave before the event concludes at 12:30 PM?*

YesNo