Supplemental Security Income (SSI) Eligibility and Benefits

Event Registration

First Name *

Last Name *

Email Address *

Phone *

Postal Code *

What School District are you affiliated with, if applicable?

Optional Donation *

Optional $5 Donation to The Arc - $ 5.00

I cannot donate at this time - $ 0.00

Optional $10 Donation to The Arc - $ 10.00

Optional $25 Donation to The Arc - $ 25.00

Total