Unified Work Mobile Academy | Cottage Grove

February 1-3, 2023

Time: 9:00 am - 2:30 pm

Location: Rise (Cottage Grove) | Google Maps
8619 W Point Douglas Rd S #150
Cottage Grove, MN 55016

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Participant Name*

First Last

Email Address*

Phone Number*

T-Shirt Size*

Are you connected with an organization?

This might be an organization where you receive job or other related services. If you don't receive services, please leave blank.

Please list any needed accommodations that will help you be successful in the class:

Will you be bringing a support person?*

(If you feel you are unable to successfully and safely participate independently, please plan to bring a support person with you!)

Yes

Name of Support Person*

Relationship of Support Person to Participant*

Do you have any significant medical issues, food allergies, etc. that the trainer(s) should be aware of?*

Yes

Please describe:*

Emergency Contact Name*

Emergency Contact Relationship*

Emergency Contact Phone Number*

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