Fixit Clinic Registration Form

The Fixit Clinic will be held on Friday, October 25, 2024 from 8:00am to 1:00pm at Fuse Makerspace located at 101 Broadway Blvd NE.

First Name

Last Name

Phone Number Use format xxx-xxx-xxxx

Contact Email Must contain @domain.com

Item Bringing in for Repair Describe the item you are bringing in to repair and what is wrong with it.

characters remaining

Appointment Time What time would you like your appointment to be?

8 am
9 am
10 am
11 am
noon

How Did You Hear About the Event? Indicate how you heard about the event. If other please specify below.

If Other Specify Here Please specify where you heard about the event.

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Please confirm all required fields are populated before submitting your form. Your form is not submitted until you see the confirmation page which includes a recap of your completed form fields.

Fixit Clinic Registration Form

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