HECBC Berks County Conference Guests

Guest's First Name

Guest's Last Name

Guest's Email Address

Mobile Phone Number

Will you be having lunch on-site at the conference?

Dietary Restrictions - Hold ctrl and click the options to select more than one

**Persons with disabilities, who need accommodations for this event, should notify the Disability Services Office two weeks prior to the event at (610) 683-4108 or email DSO@kutztown.edu , TDD number: 610-683-4499, in order to discuss accommodations. Every effort will be made to provide reasonable accommodations.**