COMMUNITY BRUNCH with Central Queens Against Hate: Breaking Bread, Building Bonds RSVP form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

COMMUNITY BRUNCH with Central Queens Against Hate: Breaking Bread, Building Bonds RSVP form

Central Queens Against Hate (CQAH) is a coalition of community organizations, NYC agencies, leaders and everyday New Yorkers coming together to help build the foundations for a more inclusive and equitable society in Queens. We are excited to open a space to share our traditions, stories and cultures together in conversation over a delicious meal, sponsored by Mayor Adam's Breaking Bread, Building Bonds initiative. We can't wait to meet you!

Sunday June 16, 10-12 pm

68-60 Austin Street, 7th Floor, Forest Hills NY 11375

Doors open at 9:45 am, conversations and meals begin at 10:15 am.

Inclusive dietary options available

***EACH ATTENDEE NEEDS TO REGISTER SEPARATELY TO ENSURE WE WILL HAVE A SEAT AVAILABLE FOR THEM. IF YOU WOULD LIKE TO ATTEND WITH ANOTHER GUEST, PLEASE SHARE THIS SURVEY WITH THEM***

Questions? Please reach out to Mark (marklstr99@gmail.com) or Amy (amy.long@earthcitizens.org)

Email *

First Name *

Last Name *

Have you been to a Breaking Breads, Building Bonds event before?
*

Yes, I have attended this event at this location before.

Yes, I have attended this event at another venue.

No, it's my first time!

Which community based organization or NYC agency are you affiliated with? (If none, how did you find out about this event?) *

Do you follow any of these dietary restrictions?

Food allergy (please specify in the "Other" category)

Gluten-free

Halal

Kosher

Vegan

Vegetarian

No, I do not follow any of these dietary restrictions

Other:

Do you have any access requirements you would like us to be aware of?

Mobility Support (Please specify in the "Other" option below).

Language Access (Please specify in the "Other" option below).

No, I do not have any access requirements.

Other:

What are you hoping to gain from your experience at this Community Brunch?

Is there anything you'd like us to know before you attend?

(As a reminder, if you have others who are attending from your organization, everyone must register separately to ensure we will have a place for them.)

Special thanks to our coalition partners: Forest Hills Green Team, Earth Citizens Club of Queens NY, NYC Commission on Human Rights, Forest Hills Asian Association, Community Board 6, 112 Precinct, Commonpoint Queens, NYC Office for the Prevention of Hate Crimes, Queens Community House, Chazaq, Let's Talk Democracy, LIJ Forest Hills, Brain Power Wellness, Congressmember Grace Meng, City Councilmember Lynn Schulman, and State Assemblymember Andy Hevesi

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Earth Citizens Organization.

Does this form look suspicious? Report

Forms