GoKits for AFN and senior communities
Sign up to participate in BDPNN's free emergency GoKit program (2020) specifically designed for seniors, people with disabilities, and caregivers. You must live or work in Berkeley, California, to participate.

All information provided here will be kept confidential. You can participate if you don't have an email address. If you do not have an email address, enter "info@bdpnnetwork.org" and provide a cell number where we can text you.
Email address *
Name
(Please note that you do not need to use your legal name, but we'll need some way to identify you.)
Your answer
How would you like us to contact you? *
Please provide your phone number if you'd like to be contacted by text.
Your answer
Please check any or all that apply. I am a:
Note that your answer does not affect eligibility.
I can attend a GoKit distribution session
I need accommodations:
Your answer
Zip Code
for residence or place of work
Your answer
I would be willing to participate in a preliminary focus group aimed to make this program more efficient and effective.
A copy of your responses will be emailed to the address you provided.
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