JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
BCBS COVID Conversations RSVP Conversaciones
Please reach out to
lauren@marnitastable.org
with questions.
Comuníquese con
marlene@marnitastable.org
si tiene preguntas.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
First Name/Nombre
*
Your answer
Last Name/Apellido
*
Your answer
Organization/Place of Employment - Organizacion /Lugar de trabajo
Your answer
County/Region
Your answer
Which session are you attending? ¿A qué sesión asistirás?
*
Thursday - Jueves, February 18th 1pm-4pm
Saturday - Sabado, February 27th 10am-1pm
Thursday - Jueves, March 4th 12pm-3pm
Friday - Viernes, March 12th 12pm-3pm
Friday - Viernes, March 19th 10am-1pm
Thursday - Jueves, March 25th 1pm-4pm
Who did you learn about this event from? ¿Cómo se enteró de este evento?
Your answer
Do you need translation support to participate? ¿Necesita intérprete?
Spanish/Español
Somali
Other:
Clear selection
What type of device are you planning to use during the event?/ ¿Qué tipo de dispositivo electrónico planeas utilizar durante el evento?
Phone with zoom app/ Teléfono con la aplicación de zoom
Phone (call in to the meeting)/Teléfono (llamar a la reunión)
Tablet/Tableta
Computer/ Computadora
Clear selection
Do you need any help or support connecting to zoom? ¿Necesita apoyo para conectarse?
Yes/Si
No
Clear selection
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of Marnita's Table.
Report Abuse
Forms