Event Registration Form
Thank you for your interest in attending this event. 

Your registration information helps us tailor our content and delivery to your unique needs. 

We look forward to seeing you soon.
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What is your first name? *
What is your last name? *
What is your email address? (personal email addresses are preferred to bypass spam filters) *
What is the date of the event you're attending?  *
What is the title of the event you're attending?  *
Which best describes your role in attending this event? 
How many children will be attending this event with you?  *
How many other adults from your household will be attending this event with you? 

*We ask that adults from other households register separately*
What is the zip code of your current home or residence? 
Are you Hispanic, Latino, or of Spanish origin? *
How would you describe yourself (select all that apply) *
Are you military-connected (i.e., have you or your spouse served or currently serve in the US Armed Forces)?  
Which best describes you or your service member’s current military status?  
Which service branch best represents you or your service member’s current affiliation?  
Which best represents you or your service member's military rank?  *
Do you provide unpaid care to a wounded, injured, or ill service member or veteran? *
There may be photographing or videos/video taping done during event. As a result of your participation, your name and likeness may be used or displayed in MCEC print or video publications, web pages, multimedia, or displayed advertisements

If you have an extenuating circumstance that prohibits you from agreeing to this photo release, please add as much detail as you're comfortable with in the "other" section below so we can plan accordingly. 
Course materials are under copyright, trademark or other intellectual property protections. Materials, methods, knowledge and skills may be used provided MCEC or third party author is cited appropriately. Permission is required prior to copying materials
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