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Upcoming Circles Registration

On-line Registration Form

Please note that to use this form you must be connected to the internet and provide a valid email address for yourself.

Diversity Circle # registering for:

Name:

Address:

County of Residence:

Home Phone:

Work Phone:

Email Address *required:

I require a translator. For this language:

Questions and/or Comments?

Accomodations needed for disabilities or limitations:

The following information is not mandatory, but if provided will help us make sure that each Circle has a diverse mix of participants.

Gender: or

Age: , , ,

Race/Ethnicity:

Registrants will be contacted to confirm the date, time and place at least one week prior to the circle.

If your browser does not support forms you can email your information directly to: Linda Hunter, Email: linda.hunter@uwc.edu

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UW-Extension © 2008 Board of Regents of the University of Wisconsin System, doing business as the Division of Cooperative Extension of the University of Wisconsin-Extension. If you have any questions regarding this site's contents, trouble accessing any information on this site, require this information in an alternative format or would like to request a reasonable accommodation because of a disability email: linda.hunter@uwc.edu UW-Manitowoc