Earth Day Conference Event Registration
Event Date: Friday, April 22nd, 2022
Event Time: 9:30am-1:00pm*
Event Address:
Museum of the City of New York
1220 5th Ave, New York, NY 10029**

*East Harlem residents over the age of 18 who attend in-person, complete the CB11 Statement of District Needs survey and provide an email address and address in the district will be given a $50 gift card for attending for the full event. Manhattan Community Board members are ineligible for gift cards. A light breakfast and lunch will be provided.

**Please use entrance on 104th St.

Contact us at eosp@cb11m.org with any questions.
Sign in to Google to save your progress. Learn more
Full Name *
Email *
Address *
Dietary restrictions *
I understand that I must be over the age of 18, attend in-person for the full event, complete the CB11 Statement of District Needs survey, and provide an email address and address in the district in order to receive a $50 gift card. *
Required
By attending The CB11m Earth Day Conference, I authorize Manhattan Community Board 11’s agents, successors, assigns and designees to record my name, likeness, image, voice, and sound effects on film, tape or otherwise, edit such recording as Manhattan Community Board 11 may desire, and incorporate such recording into a film, any versions of a film, and related materials thereof, including, but not limited to, promotion and advertising materials. Manhattan Community Board 11 shall retain final control over the film and photos and may use them in all markets, manner, formats and media/social media in perpetuity. *
Do you require additional assistance at the event (e.g. translation, ADA accessibility, audio/visual aids)?
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Manhattan Community Board 11.

Does this form look suspicious? Report

Google Forms