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Provider Agency Registration Form
Florida Stand Down for Homeless Veterans
Friday, October, 2, 2026
Brownsville Community Center
3200 West De Soto
Pensacola, FL 32506
Please submit this form by close of business on
September 16, 2026.
Contact Mary L. Watson for questions at:
mlwatson.gcvac@gmail.com or
(850) 293 - 0369
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Last Name
Your answer
First Name
Your answer
Title
Your answer
Organization
(Please list name of organization exactly how it should appear on your table tent)
Your answer
Phone Number
Your answer
Email Address
Your answer
Address
(include city, state, and zip code)
Your answer
Will you need internet service access?
Choose
Yes
No
Will you need more than 2 chairs at your table? If yes, how many total?
Your answer
Will you need an additional table?
(limited supply)
Choose
Yes
No
Please list the names and titles of the individuals who will represent your organization at your table.
Your answer
How many bus tickets will you need for your clients?
(Remember one bus ticket is good for transportation only on this day to and from Brownsville Community Center)
Your answer
Can your agency provide water?
Choose
Yes
No
Please specify any special requests below:
Your answer
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