Request Form | Active Transportation Alliance

WORKSHOP REQUEST FORM

You can make your block a safer and more active place. The Active Transportation Alliance will host a FREE workshop with you and your neighbors to discuss speeding traffic, dangerous intersections, broken sidewalks and more. Plus learn about the ways you can make your block a safer place to live and play.

Contact Name: *

Organization Name: *

Address: *

Zip Code:

Phone Number: *

E-Mail:

Workshop Location: *

Event Type: *

Event Other:

Site:

Indoor

Outdoor

Number of people attending: *

There must be a minimum of 5 adults/youth present during the workshop.

Audience:

Adults

Children

Both

Event Date:

Start Time:

End Time:

How did you hear about Better Blocks?: *

Please Specify:

Additional Information:

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