Kentucky Fatherhood Summit 2022

Event Registration

Event Details

Kentucky Fatherhood Summit 2022 – October 11-12

Registration Information

* Registration Type

General Attendee

Nonprofit/Faith Based Organization

Government (Local, State, Federal)

* First Name

* Last Name

Email Address

example@kentucky.gov

Phone Number

* State of Residence

* County of Residence (required for Kentucky residents)

* How will you attend

* Please select which day(s) you would like to attend

Please select t-shirt size

Please enter dietary restrictions, if any

If any language assistance is required, please list what assistance is needed?

Check if you are attending for work

Organization

Organization Type

Non-Profit

Government

Other

Organization Name

Position

Organization Address 1

Organization Address 2

Organization City

Organization State

Organization Zip Code

Organization Phone Number

Is your Organization interested in learning more about exhibitor opportunities at the Summit?

Organization Contact

Contact Phone Number

Contact Email

Child Support

Disclaimer: The below answer is only for purpose of data collection to help us provide better service to our community. All data collected will be computed anonymously

* Do you currently pay or receive child support?

* Please identify which best represents/represented your role

I am a parent

I am a caregiver

Not Applicable