Project Homeless Connect Buffalo 2019 Service Provider Registration
PHC Buffalo is happening Thursday, October 10, 10am-4pm at the Buffalo Niagara Convention Center
Please register by September 26 so that we can accommodate your needs
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Email *
Name of Individual or Organization *
Contact Name *
Street Address *
City *
Zip Code *
Contact Phone Number *
Contact Email *
Agencies will be arranged service categories. Please identify the area you would like your table to be located in *
Provide a brief description of the services you/your agency will provide at this event
Will you need access to electrical outlets?
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If yes, how many outlets will you need access to?
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Each registered agency will be provided with a 8ft table and two chairs (with an additional two chairs for clients) and two boxed lunches. Please specify if you need other or additional accommodations i.e. private meeting area, additional chairs, additional lunches, vegetarian lunches etc  
Please include any additional information that may help us better accommodate your needs.
A copy of your responses will be emailed to the address you provided.
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