Kalamazoo Community Roundtables: Interest Form
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What is your name? *
What is your email address? *
What is the best phone number to contact you at?
What is your age? *
What gender do you identify as? *
Which of the following primarily describes your race/ethnic background? Please select all that apply. *
Required
Including yourself, how many people live in your household?
What is your occupation? *
Where is your primary residence or business located within Kalamazoo County? *
What is your zip code? *
Are you involved in or do you work for any of the following groups or organizations?
Are you be available to attend an in-person Community Roundtable Discussion on Tuesday, June 28 from 5-7 PM in Vicksburg? *
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