Walworth County Family Living Communication List
Completing this, you will be added to communication lists that you are interested in. Communications will include notification of upcoming education opportunities, helpful information, community resources and other updates of note.

If you'd like to be removed from a list, please contact Amanda at amanda.kostman@ces.uwex.edu or 262-741-4961 or Gonzo at gvega@co.walworth.wi.us or 262-741-4951.

First Name
Your answer
Last Name
Your answer
Demographic information
Please provide the following demographic information about yourself. This information is used to ensure our programming is reaching a diverse audience and to fulfill our obligations as a recipient of federal funding. You reserve the option to not provide this demographic information. Should you choose not to provide this information, please choose "Prefer not to respond."
Please indicate your gender
Please indicate your race
Please indicate your ethnicity
Please indicate your age
Communations
Most communications will be via email but occasionally a physical mailing, text messaging or phone calls may be used. Please only provide the information for the communication methods you''d prefer us to use to contact you.
Primary Email Address
Your answer
Secondary Email Address
Your answer
Address (first line: street number)
Your answer
Address (Second line: city, state ad zip code)
Your answer
Phone Number (where you prefer phone calls)
Your answer
Text Number (where you prefer text messages sent)
Your answer
Other
Your answer
What would you like to hear about?
Which types of program topics would communications about?
yes please
no thank you
Financial Capability (spending plans, credit and debt, financial coaching, etc)
Healthy Lifestyles (health, physical fitness, nutrition, food safety, food preservation, mindfulness, etc.)
Human Development and Family Relationships (parenting, communicating across generations, aging communicates, etc)
Any other comments:
Your answer
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