Parkinson's Symposium Fall 2024

Name

Address

Cell Phone Number

I plan to attend

In-person
Virtually
Zoom link will be sent to you separately.

The questionnaire below is optional, but please consider filling it out because it helps us better serve the Parkinson's community.

Which answer describes you best?

What is your age?

What is your gender identity?

Male
Female
Other, if other please specify
Prefer not to say

Do you have dietary restrictions? If so, please specify

How did you hear about this event?

Social Media
Flyer
A friend or family member
Other

Would you prefer this content be made available in another language? If so, which language?

Photo Waiver

I hereby grant to the Tampa JCCs and Federation and their legal representatives and assigns, the irrevocable and unrestricted right to use and publish photographs and/or motion picture/video film of me, or in which I may be included, for editorial trade, advertising and any other purpose and in any manner and medium; and to alter the same without restriction. I hereby release the Tampa JCCs and Federation and their legal representatives and assigns from all claims and liability relating to said photographs, film, video recordings, videotapes, and all other visual mediums.

Almost done. Where should we send the confirmation?

Name