PROJECT HOMELESS CONNECT ROCHESTER-PROVIDER INFO
This form is for agencies/service providers who would like a booth at Project Homeless Connect Rochester on Sept. 13, 2018. If you have questions, please contact kbryan@pathstone.org or barbara.grosh@homelessconnectrochester.org
Agency Name *
Your answer
Services Provided *
Please give us a two-sentence description of the services you will provide, so that our volunteers can help guests find what they need
Your answer
Contact name: *
Who can we contact in advance if we have questions?
Your answer
Contact address:
Address of contact
Your answer
Phone: *
Phone number for contact
Your answer
Cell *
What's a cell number we could use the day of the event for an agency contact?
Your answer
Email *
Email for agency contact
Your answer
How many tables do you need in your booth?
booths are 10'x10' and come with 1 table unless you request more
Your answer
How many chairs do you need in your booth?
Your answer
Do you need a private room off of the floor?
please describe your needs. Availability is limited.
Your answer
Do you need some privacy on the floor?
please describe your needs
Your answer
Do you need electrical connections?
please describe your needs
Your answer
Number of volunteers who will be in booth
Your answer
Names of volunteers who will attend
Your answer
Other
Is there anything else you'd like to tell us to ensure we give you the best space we can for your needs?
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.