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
Email *
First Name/Nombre *
Last Name/Apellido *
Organization/Place of Employment - Organizacion /Lugar de trabajo
Which session are you attending? ¿A qué sesión asistirás? *
Who did you learn about this event from? ¿Cómo se enteró de este evento?
Do you need translation support to participate? ¿Necesita intérprete?
Clear selection
What type of device are you planning to use during the event?/ ¿Qué tipo de dispositivo electrónico planeas utilizar durante el evento?
Clear selection
Do you need any help or support connecting to zoom? ¿Necesita apoyo para conectarse?
Clear selection
A copy of your responses will be emailed to the address you provided.
Clear form
Never submit passwords through Google Forms.
This form was created inside of Marnita's Table. Report Abuse