Countywide Community Forums - King County Registration

1 - Personal Info

Personal Info	This is the personal contact information that is necessary to establish your account on this system. Please provide your email address if you have one so we can communicate with you as easily and inexpensively as possible. If you do not provide an email address, then we must send you letters using expensive regular mail.

First Name*	Middle initial	Last Name*


Primary Contact Telephone* Please enter number in this format: XXX-XXX-XXXX (No parenthesis or spaces are accepted)

Alternate Contact Telephone Please enter number in this format: XXX-XXX-XXXX (No parenthesis or spaces are accepted)


E-mail Address
Please re-type your E-mail Address for verification

Password*
Confirm Password*

Email Format


Home Address	To qualify as a Citizen Councilor you must either live, or work, inside King County. PO and Private Mail Boxes are not allowed in this section. You may indicate a PO Box in the Preferred Address section further down.

Home Address	Home Unit/Apt./Suite/etc

Home City	State	Zip
	, Washington
Home County



Work Address	To qualify as a Citizen Councilor you must either live, or work, inside King County. PO and Private Mail Boxes are not allowed in this section. You may indicate a PO Box in the Preferred Address section further down.

Work Address	Work Unit/Apt./Suite/etc

Work City	State	Zip
	, Washington
Work County



Preferred Address	Please indicate which address you prefer to use for any physical mail that we send to you. If you choose "Other", please provide us with your preferred address. PO and Private Mail Boxes are allowed in this section.
What is your preferred address for materials mailed to you from our offices?*

Home Work Other

Volunteering Info


May we send you occasional e-mail invitations and information about hosting small group meeting for Countywide Community Forums?*
Yes No

Are you willing to possibly assist the host of any small group meeting that you attend by receiving, printing, and distributing electronic information for your fellow participants?*
Yes No

The Countywide Community Forum is a volunteer program that operates without paid staff. May we contact you occasionally to describe volunteer opportunities within this program?*
Yes No

How did you first learn of Countywide Community Forums?


Optional Organizational Code If your organization is encouraging your participation in this program, please provide its assigned code here.

2 - Demographics




The auditor and coordinator for these Countywide Community Forums request your answers to the following questions. Your answers are OPTIONAL and VOLUNTARY. If provided, your answers will help us better understand the diverse range of Citizen Councilors enrolling in this program.

What is your gender?		Male Female Undisclosed

What is your age?

Are you of Hispanic or Latino ethnicity? (A person of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin unique to the Americas, regardless of race.)		Yes No Undisclosed

What is your racial heritage?

What is your primary Employment Status?

What level of Education have you completed?

What is your primary Household Family Description?

General Notes You may leave any comments/notes for us here.

3 - Confirmation


Please review your information on the previous tabs. When you are sure it is correct, click on the Submit button below to complete your registration. Afterwords, you may log in using your ID and Password (your ID is either your E-mail address or a code we will create for you if you do not have an E-mail address). After you log back on, either find a host near you or become a host yourself for others to find. THANK YOU for registering as an official, volunteer, Citizen Councilor for King County!