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Community Event Registration
LVCM CDC · Open to everyone · No account needed
Works on iPhone · Android · Any browser
1
📅 Select Your Event
Tap the event you are registering for
⏳ Loading events…
2
👤 Your Information
Name and phone are required
First Name
*
Last Name
*
Cell Phone
*
We'll use this to keep you updated about events
Email Address
Optional — helps us send event updates and follow-ups
3
🏠 Where Are You From?
Helps us connect you to neighborhood resources
Street Address
City
State
NC
VA
SC
GA
TN
MD
DC
Other
ZIP
Neighborhood / Community
e.g. East Winston, South Side, Cleveland Ave, Greensboro NE
4
🍽️ Event Details
Help us prepare for your visit
Will you be eating at this event?
*
✅ Yes, I'll eat
❌ No, thank you
Photo & Video Consent
*
— Please select —
✅ Yes — photos and video
📷 Yes — photos only
❌ No — please do not photograph me
How did you hear about this event?
— Select one —
Flyer
Social Media
Friend or Family
Church / Faith Community
Door Knock / Canvass
QR Code
Email
Text Message
Neighbor
Other
5
🙋 How Would You Like to Participate?
Optional — let us know if you want to do more than attend
I am attending as…
Businesses, employers, and workforce organizations welcome
Community Member
Faith Leader / Pastor
Healthcare Provider
Community Organizer
Business Owner
Hiring Employer / Recruiter
Workforce Development Rep
Educator
Nonprofit / Organization Rep
Student
Volunteer
Other
I'm also interested in helping with…
Select all that apply
🏪 Resource / information table
💼 Hosting a hiring table / job tabling
📋 Screening job applicants on-site
🤝 Sponsoring this event
🎤 Speaking or presenting
🎵 Performing / music
🚪 Canvassing / community outreach
🙋 General volunteering
6
💬 Your Community Voice
Optional — help us build better programs and connect resources
🌍 Community Input
What health or community issues would you like to see addressed?
This is confidential — helps us plan programs for your neighborhood
Tell us more — describe the problem in detail
The more you share, the better we can bring real solutions to real problems in your community
🤝 Organizations or People We Should Connect With
Recommended partners, community leaders, churches, businesses — up to 2 contacts
Contact 1
Name
Organization
📱 Mobile / Phone
✉️ Email
Contact 2
Name
Organization
📱 Mobile / Phone
✉️ Email
Suggestions or ideas for future events?
📬 Yes — I'd like LVCM CDC to follow up with me personally
📖 Share Your Story (Optional)
Your story helps us advocate for community health and healing. All fields are optional and confidential unless you give permission to share.
📖 I'd like to share my story with LVCM CDC
✅ Complete My Registration
🔒 Your information is kept confidential and used only by LVCM CDC.
Questions? Call
(336) 925-4045