register 3 — povertythoughtforce

Register for the World Café on Health & Wellness

March 17, 6 - 7:30 p.m.
St. Peter’s Church & World Outreach Center
3683 Old Lexington Rd, Winston-Salem

Contact information will allow organizers to confirm your attendance and notify you of any changes. Space is limited and you may be placed on a wait list. If you do not have access to the Internet, call (336) 758-4021 to register.

Name

First Name

Last Name

Email Address

Telephone

Street Address

City

State

Zip Code

I am representing:

Myself

An organization

If you are representing an organization, what is the name of your organization?

If you are participating as an individual, please type N/A

Which role or sector will be your primary identification at this meeting?

This will assist us in knowing the composition of our attendees.

Non-profit

Government

Business/private sector

Faith-based

Community Member