Homeless Connect Service Provider Registration for Sunday October 6th , 2019
Organization Name: *
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Contact Name: *
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Email *
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Address *
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City *
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Province *
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Postal Code
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Phone *
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Cell Phone *
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On site contact (if different from above)
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On site email address *
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On site cell phone # *
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Please give a short description about your orgaization *
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Please describe the service you are providing *
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How do you categorize your service? *
Required
Are there any organizations you would like to be near? (we will do our best to accommodate)
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How many staff/volunteers will you be bringing? *
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Are you providing medical or counselling services that require more privacy in your booth space. Please check yes and your space will be provided with 8' privacy drapes. Please confirm this in advance, as it cannot be changed on the day of the event. *
Required
Will you need an internet connection?(please note that this is a wireless connection and must be ordered in advance. *
Will you need a sink/running water? *
Each booth will receive 1-8ft. table (except special services areas), if you require additional tables, please let us know how many.
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Each booth will receive 2 chairs, if you require additional chairs, how many?
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Other requests will be accommodated if possible. Please list in detail your requirements and you will be contacted in advance if we have any questions.
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Homeless Connect provides T-Shirts to service providers, in the interest of reducing waste and added expenses we do ask that you re-use your shirt from the past Homeless Connect events. If you require a T-Shirt's please indicate how many of each size. Registrations after Sept 21st cannot be guaranteed a size. *
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How many small?
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How many medium?
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How many large?
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How many X-Large
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How many XX-Large
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How many XXX-Large
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