It's Complicated: Exploring Sexuality, Identity, and Relationship Issues for People with Intellectual Disabilities

Please register below by November 28, 2022 to attend EEDA's It's Complicated: Exploring Sexuality, Identity, and Relationship Issues for People with Intellectual Disabilities on December 03, 2022 at Hotel Indigo.

STOP!
Please do not register unless you are absolutely sure you are able to attend. In the event that you register and cannot attend, please call 631-369-7345 Ext. 117 or email info@eed-a.org in advance so we can offer your spot to someone on the waiting list.

I agree to confirm my registration prior to the event. *

I Agree

* Indicates required field

How many people will be attending? *

Name: *

First

Last

Mailing Address: *

Line 1

Line 2

City

State

Zip Code

Country

Email Address: *

Cell Phone: *

PLEASE LET US KNOW WHO YOU ARE *

This program is funded through a Family Support Services grant from OPWDD.

If you are the parent or family member of an individual with intellectual disabilities or a professional using this information to assist those you support, please provide us with the:

Individual's Name: *

First

Last

Individual's TABS ID#: *

Is the Individual Enrolled in the MCBS Medicaid Waiver? *

Yes No

Does the Individual Have Medicaid? *

Yes No

Thank you for completing this form!
Please click the submit button below to complete your registration.

Submit