Hope Connection Service Provider Registration

Would you prefer to download the registration form? click here

Service Category of Organization (please select one):

Business (For Profit)
Church/Faith-Based Organization
Foundation/Philanthropic
Government - Federal
Government - State
Government - Local
Civic Organization
Educational Institution
Non-profit

Category of Service Organization Will Provide at Hope Connection (select as many as apply):

Medical Service
Specify:
Children's Services
Mental Health Service
Substance Abuse Treatment
Legal Support
Housing
Specify:
Employment
Basic Needs
Specify:
Legal Documentation
Specify:

One table and two chairs will be provided at each provider’s table. If you need additional amenities, such as close proximity to an electrical outlet, internet connection, etc., please let us know:

To ensure we have an accurate count for lunch, please tell us how many individuals will be attending from your agency:

What forms of identification will you require from clients (e.g. picture I.D., Social Security card, birth certificate, etc.)?

We invite agencies to bring an identifying banners to hang at their respective booths (grommets required). Please indicate whether your agency will be bringing a banner. If you answer "no," a generic paper sign will be provided for you.

Yes
No

*A Community Partnership staff person will be taking photographs during the Hope Connection event. If you or any other volunteer from your organization wish NOT to be photographed, you must pick up and wear a sticker from the registration table that will indicate your desire not to be photographed.*