Community Resource Connect - AGENCY REGISTRATION
Please complete this form to register your organization to be a service provider at Community Resource Connect on September 12, 2019. This event is being hosted by the Portage Housing Services Council. All questions regarding registration can be directed to Lauren Green-Hull at
Email address *
Agency Name *
Your answer
Program Name (if applicable)
Your answer
Agency/Program Contact Name *
Your answer
Contact Phone Number *
Your answer
Please identify the specific service(s) your organization will be providing at the event. *
Your answer
Please list any items you will be giving away at the event. *
Your answer
How many tables will you need at the event? *
Your answer
Will you need electricity to provide your service? *
Will you need internet access to provide your service?
Do your services require privacy? *
If you require privacy, please explain your needs.
Your answer
Can we use your agency's logo on event materials/promotions?
If yes, please email your logo to
Please provide one paragraph stating your agency's mission and explaining the service(s) you will be providing. *
This information will be used to properly direct guests to your services the day of the event.
Your answer
A copy of your responses will be emailed to the address you provided.
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