F2F Registration

CELLULAR: EMAIL:

WOULD YOU LIKE TO BE ADDED TO AN EMAIL LIST TO RECEIVE MEETING NOTICES AND CURRENT INFORMATION OF INTEREST? YES NO

If you are just completing a basic registration, you do not need to complete the next section, just click Submit Form

If you are completing the SURVEY information, please click the SUBMIT FORM button at the bottom of the page below

EXPANDED REGISTRATION AND SURVEY FORM

ETHNICITY

AFRICAN AMERICAN ASIAN AMERICAN CAUCASION HISPANIC NATIVE AMERICAN OTHER

If Ethnicity is OTHER please enter:

SPOUSE OR PARTNER INFORMATION

FIRST NAME: LAST NAME:

ORGANIZATION: TITLE OCCUPATION:

ADDRESS: COUNTY:

CITY: SCHOOL DISTRICT:

STATE: SPOUSE ZIP:

SPOUSE ETHNICITY:

AFRICAN AMERICAN ASIAN AMERICAN CAUCASION HISPANIC NATIVE AMERICAN OTHER

If Ethnicity is OTHER please enter:

CHILD

FIRST NAME: LAST NAME:

GENDER: MALE FEMALE

ETHNICITY:

AFRICAN AMERICAN ASIAN AMERICAN CAUCASION HISPANIC NATIVE AMERICAN OTHER

If Ethnicity is OTHER please enter:

DISABILITY: YES NO - if YES, please enter DISABILITY TYPE:

CHILD

FIRST NAME: LAST NAME:

GENDER: MALE FEMALE

ETHNICITY:

AFRICAN AMERICAN ASIAN AMERICAN CAUCASION HISPANIC NATIVE AMERICAN OTHER

If Ethnicity is OTHER please enter:

DISABILITY: YES NO - if YES, please enter DISABILITY TYPE:

CHILD

FIRST NAME: LAST NAME:

GENDER: MALE FEMALE

ETHNICITY: AFRICAN AMERICAN ASIAN AMERICAN CAUCASION HISPANIC NATIVE AMERICAN OTHER

If Ethnicity is OTHER please enter:

DISABILITY: YES NO - if YES, please enter DISABILITY TYPE:

PLEASE EMAIL INFORMATION TO FAMILY TO FAMILY NETWORK IF THERE ARE MORE THAN THREE CHILDREN.

FAMILY TO FAMILY BUSINESS

WHEN WAS THE LAST TIME (DATE) YOU ACTUALLY HAD BUSINESS OR PARTICIPATED WITH F2F?

WHAT TYPE OF SERVICE WAS PROVIDED OR ACTIVITY DID YOU PARTICIPATE IN?

• WHAT TYPE OF ACTIVITIES HAVE YOU PARTICIPATED IN WITH F2F? (PLEASE CHECK ALL THAT APPLY)

READ NEWSLETTER

LENDING LIBRARY

GALA

VOLUNTEER

CONNECTIONS TRAINING

PORTFOLIO TRAINING

MEETINGS MONTHLY SPEAKERS

PARTNERS IN POLICY MAKING

FUNDRAISING

HOLIDAY PARTY

FOCUS GROUPS

ARD CLINICS

NETWORKING WITH OTHER MEMBERS INFORMALLY

USE F2F WEBSITE

OTHER (PLEASE DESCRIBE)

• IF YOU DO NOT PARTICIPATE IN ANY F2F ACTIVITIES, WHY NOT? (PLEASE CHECK ALL THAT APPLY)

LOCATION OF MEETING

TIME OF MEETING

TOO BUSY

NOT INTERESTED IN MEETING

TOPICS NOT OF INTEREST TO ME

DO NOT CONSIDER MYSELF A MEMBER

OTHER (PLEASE EXPLAIN)

• WHICH PROJECT OR COMMITTEE WOULD YOU CONSIDER VOLUNTEERING FOR?

HELP WITH AN ARD CLINIC

HELP WITH MAIL OUTS

WORK ON GALA OR OTHER

COMMUNITY OUTREACH

PUBLIC RELATIONS

VOLUNTEER AT HOUSTON GOLF ASSOCIATION EVENTS

PROVIDE PARENT TO PARENT SUPPORT

BRING FOOD / DRINK TO MEETINGS

CONTRIBUTE TO NEWSLETTER

SERVE ON A COMMITTEE

MEMBERSHIP COMMITTEE

FUNDRAISING COMMITTEE

OTHER COMMITTEE:

WHAT WOULD YOU LIKE TO SEE ADDED TO F2F TO MEET YOUR (YOUR CLIENT'S) CURRENT OR FUTURE NEEDS?:

WHAT TOPICS WOULD YOU LIKE TO LEARN MORE ABOUT FROM SPEAKERS/NEWSLETTER?

PARENTS WOULD YOU BE WILLING TO SHARE INFORMATION WITH:

• OTHER PARENTS THAT HAVE CHILDREN WITH DISABILITIES: YES NO

• MEDICAL SERVICE PROVIDERS: YES NO

• EDUCATIONAL SERVICE PROVIDERS: YES NO

MEDICAL AND EDUACTIONAL SERVICE PROVIDERS

WOULD YOU LIKE ADDITIONAL INFORMATION OR BROCHURES THAT YOU CAN SHARE WITH OTHERS? YES NO • IF SO HOW MANY:

DO YOU REFER CLIENTS TO F2F: YES NO • IF SO HOW OFTEN?

IF NOT, WHY NOT:

PLEASE LIST ANY ADDITIONAL COMMENTS (PLEASE SEND ANY ADDITIONAL COMMENTS VIA EMAIL F2F CONTACT)