Fort Gratiot REC-IT Night
Come join us on the 4nd Monday of each month .  Support and modifications will be provided to ensure a successful evening for everyone.  Please complete this registration form to be added to the monthly class roster.  A reminder email will be sent prior to each monthly class.  Class takes place at our Fort Gratiot location.  Disability Network Eastern Michigan, 4040 24th Ave, Fort Gratiot, MI
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Email *
Name (First and Last) *
Email *
Address  *
City  *
Zip *
Phone Number *
Date of Birth ( needed for federal grant reporting purposes only) *
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DNEM offers free programs to people with disabilities.  Please assist us with accommodating your needs by identifying any disabilities you have:   *
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