RSVP to Oregon Hunger Task Force Listening Session - Douglas County
Tuesday, July 23, 2019
Roseburg, Oregon

Photo: North Umpqua River, Bureau of Land Management

Email address *
I plan to attend the Listening Session *
Required
Name *
Your answer
Pronouns
Check all that apply. Click to learn more about why we ask for pronouns: https://oregonhunger.org/pronouns-policy
Email
Your answer
Phone
Your answer
Organization
If you are affiliated with an organization, business, or other entity, please share here.
Your answer
Title
If you are affiliated with an organization, business, or other entity, please share in what capacity here.
Your answer
City/Town/Township, State *
Your answer
Have you accessed any kind of social services in Douglas County, now or in the past?
Indicate any dietary preferences *
Please share below if you have questions or if there is an accommodation we can offer to meet your needs.
We want you to be able to participate fully in the Listening Session! Please share below if you have questions or if there is an accommodation we can offer, such as offering further information about the site, handouts in large print, etc.
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Partners for a Hunger Free Oregon.