Information Session Registration for Getting Ahead

Thank you for your interest in Getting Ahead in a Just-Gettin'-By World, a 16-session workshop presented by Disability Network Eastern Michigan (DNEM) and in partnership with Thumb Community Health Partnership (TCHP) & the Thumb Opioid Response Consortium.

Please complete the registration form below to reserve your spot. This information session will be held virtually via Zoom. 

Sign in to Google to save your progress. Learn more
First Name:  *
Last Name:  *
Zip Code:  *
County of residence:  *
Phone Number. Please type the full 10-digits.

Example: (123) 456-7890
*
Email Address:  *
Do you have a disability? *
How did you hear about today's presentation? *
If you have further questions, comments, or concerns, please reach out to Janeen Bourlier.

Janeen Bourlier
Community Liaison & Outreach Specialist
Disability Network Eastern Michigan (DNEM)
Web: www.DNEMichigan.org
Phone: 810-987-9337 Ext. 8801
Email: JBourlier@DNEMichigan.org
*
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of DNOM.

Does this form look suspicious? Report