Home Ignition Zone Workshop Registration

✻ = Required

Name: ✻

Phone number: ✻

Email: ✻

County of Residence: ✻

Are you planning to attend the Home Ignition Workshop on Saturday August 17th, from 1:00PM - 5:00PM, at 43180 CA-49 in Ahwahnee? ✻

Yes No

Are you planning to attend the post-workshop happy hour at South Gate, from 5:30-6:30? ✻

Yes No

Do you want to join the PBA mailing list to hear about other upcoming trainings? ✻

Yes No

The following information is optional and confidential.

What is your gender? Check one.

Man/Boy Woman/Girl Nonbinary Gender identity not listed Prefer not to state

Are you Hispanic or Latino? Check one.

No I am not Hispanic or Latino Yes I am Hispanic or Latino Prefer not to state

What is your race? Check one or more.

American Indian or Alaska Native Asian Black or African American Native Hawaiian or other Pacific Islander White Race not listed Prefer not to state