LFUCHRC Public Accommodation Intake Form

Workshop Request Form

Please completely answer the following questions, telling us which workshop you are requesting. Please use the TAB key to move through the fields. Pressing enter will submit the form to the HRC.

Name
	First Name	Last Name	Middle Initial
Company Name
City
State
Zip Code
Cell Phone Number if Applicable
Work Phone Number
Email Address
Requested Date of Workshop

Workshop Requested		Americans with Disabilities
		Fair Housing
		Conflict Resolution
		How to Respond to a Complaint of Discrimination
		Human Diversity/ Prejudice Reduction
		Other (Specify)

Workshop Time Frame		8:00 a.m. - 12:00 p.m.
		12:00 p.m. - 9:00 p.m.

Thank you for submitting your workshop request.