Unified Work Mobile Academy | Duluth

August 14-16, 2023

Time: 9:00 am - 3:00 pm

Location: Udac
4724 Mike Colalillo Dr., Duluth, MN 55807

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Participants Name*

First Last

Email Address*

Phone Number*

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

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*

MEDIA RELEASE*

Do you allow Unified Work to take and use pictures of you for the purpose of marketing and promotion of classes?

Yes

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