Quarantine Cooking Registration Form | Disability Network Northern Michigan

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Quarantine Cooking Registration Form

First Name

Last Name

Address

Email

Primary Phone

Birthdate

If Disability Network needs to reach out to you, how would you like us to connect with you?

Are you a person with a disability?

Yes
No

What is your disability type?

Do you have any need for an accommodation?

Yes
No

If so, what accommodation do you need?

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