BCBS Rice & Steele Counties dIZI RSVP Form
Complete this form to register for the online community conversation for Rice & Steele counties and the surrounding areas being held on Thursday, April 8th from 6-8:30pm.

Someone from our team will be reaching out to make sure you have the Zoom link the week of the event.

Please reach out to sammie@marnitastable.org with any other questions.

Registrarse para la conversación comunitaria en línea de los condados de Steele y Rice y sus alrededores que se llevará a cabo el jueves 8 de abril de 6 a 8:30 p.m. Alguien de nuestro equipo se comunicará con usted para asegurarse de que tenga el enlace de Zoom.

Comuníquese con marlene@marnitastable.org si tiene preguntas.
Email address *
First Name/Nombre *
Last Name/Apellido *
Who did you learn about this event from? ¿Cómo se enteró de este evento?
Do you need translation support to participate? ¿Necesita intérprete?
Clear selection
What type of device are you planning to use during the event?/ ¿Qué tipo de dispositivo electrónico planeas utilizar durante el evento?
Clear selection
Do you have internet access? ¿Tiene acceso a internet?
Clear selection
Do you have access to a device to connect to the internet with a forward facing camera?/¿Tiene un dispositivo que tiene una cámara para participar?
Clear selection
Do you need any help or support connecting to zoom? ¿Necesita apoyo para conectarse?
Clear selection
Which incentive do you prefer? ¿Qué incentivo prefieres? *
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