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2022 AFJ November Family Dinner. Join Us on November 22nd from 6-8pm at the People’s Forum!
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Your Name and Contact Information
First Name
Last Name
Phone Number
Email
AFJ Mailing List
Yes
No
How did you hear about this dinner?
Family Empowerment Circle (Tuesdays)
Community Organizing Meeting (Thursdays)
YEP participant
Email
Referred by a friend (Please enter who referred you in the box below)
Other (please explain in the box below)
If you selected "Other" or were referred by someone please describe in detail here
Do you have any food allergies? If so, please describe.
If you selected "Other" for dietary restrictions, please describe in detail here.
Do you have any dietary restrictions?
Vegan
Vegetarian
Dairy Free
Gluten Free
No pork
Other (If other, please describe below)
N/A
Emergency Contact Information
First Name
Last Name
Phone Number
Do you need any accommodations?
Is there anything else you would like us to know?
Not including yourself, how many additional guests are you bringing?
No Guests
1
2
3
4
5
If you are not bringing any guests, please select "no guests." To finish your registration, scroll down to the bottom of the form, accept the covid protocol, and press "submit." If you are bringing guests, please fill out their information in the contact boxes below.
Contact 2
First Name
Last Name
Is the guest you're registering a child (under 18) or an adult?
Adult
Child
Does your guest have any food allergies? If so, please describe.
Does your guest have any dietary restrictions?
Vegan
Vegetarian
Dairy Free
Gluten Free
No pork
Other (If other, please describe below)
N/A
If you selected "Other" for dietary restrictions, please describe in detail here.
Does your guest need any accommodations?
Is there anything else you would like us to know?
Contact 3
First Name
Last Name
Is the guest you're registering a child (under 18) or an adult?
Adult
Child
Does your guest have any food allergies? If so, please describe.
If you selected "Other" for dietary restrictions, please describe in detail here.
Does your guest have any dietary restrictions?
Vegan
Vegetarian
Dairy Free
Gluten Free
No pork
Other (If other, please describe below)
N/A
Does your guest need any accommodations?
Is there anything else you would like us to know?
Contact 4
First Name
Last Name
Is the guest you're registering a child (under 18) or an adult?
Adult
Child
Does your guest have any food allergies? If so, please describe.
Does your guest have any dietary restrictions?
Vegan
Vegetarian
Dairy Free
Gluten Free
No pork
Other (If other, please describe below)
N/A
If you selected "Other" for dietary restrictions, please describe in detail here.
Does your guest need any accommodations? Is there anything else you would like us to know?
Contact 5
First Name
Last Name
Is the guest you're registering a child (under 18) or an adult?
Adult
Child
Does your guest have any food allergies? If so, please describe.
Does your guest have any dietary restrictions?
Vegan
Vegetarian
Dairy Free
Gluten Free
No pork
Other (If other, please describe below)
N/A
If you selected "Other" for dietary restrictions, please describe in detail here.
Does your guest need any accommodations?
Is there anything else you would like us to know?
Your registration through submission of this form saves you (and guests) a seat at this event and we look forward to seeing you (and your guests)! The day before the event you must email info@afj-ny.org or text (347) 973-0580 a clearly indicated negative COVID test result. A home test or lab generated test are acceptable as long as the results are clearly indicated. A blurry home test photo will not be accepted. A negative covid test submission prior to the event is needed for admission to the dinner.
Yes
I understand that admission to the event will NOT be granted if a negative COVID test picture is not received by AFJ.