test2 - Rona Fischman

Personal Information

Name

First Last

Best Contact Email*

Best contact phone*

Heard about this through*

Available classes

Please choose your preferred classes and location. If you are flexible to attended more than one set of sessions being offered, you have a place to note that below.

Tuesday Nights 7-9PM - East Arlington

Please choose the two-session program you would like to attend. Decisions about Intervention class is required before taking Bystander Intervention Practices. It is best to attend both sessions in a single month for continuity within the group.

Saturday nights 7-9 PM - West Somerville

Please choose the two-session program you would like to attend. Decisions about Intervention class is required before taking Bystander Intervention Practices. It is best to attend both sessions in a single month for continuity within the group.

Saturday afternoon - 12-4 PM East Arlington

This is a complete program in one session. There will either be one half-hour break or two 15-minute breaks.

Other dates you could attend

If your schedule is flexible and you can attend other dates, please note them here:

Waitlist Requests

If these dates and locations don't work for you, what would?

Location Preference

Do you need any of these accommodations?*

One-level space, suitable for wheelchair or walker use
Bathroom access without stairs between spaces
Designated handicapped parking at the site
Street parking a short distance from the site
MBTA access within 2 blocks of the site
Accommodations for hearing or vision impairment
It's all good. This space is fine.
other, please note below.

Language Interpretation or other needs, please list.

Suggested donation to defray costs and support the class, $15-30 a night. Please bring cash or a checkbook. You are welcome regardless of your ability to pay.