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Individual Seminar Registration

Courageous Conversation: Beyond Diversity™ - June 4 and 5, 2024

06/04/2024 09:00 AM - 06/05/2024 04:00 PM CT

Admission

$475.00

Location

TBD

If you are interested in requesting scholarship support for this program, complete this form before you register. Allow two business days for a response.

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First Name: Last Name: Email: Phone: Phone Type:

In the case of an emergency, we may send messages to program participants via text message. Please provide a mobile number and opt in above if you would like to receive messages via text. We will only text in extreme circumstances (e.g. severe weather) and will never sell or share your contact information.

We only use the demographic data below to report on our programs to the community and our funders. While not required, we appreciate you helping us tell the story of who we are reaching with this program.

Gender identity: Race identity (check all that apply):

American Indian or Alaska Native

Asian

Black or African American

Hispanic, Latinx or Spanish Origin

Middle Eastern or North African

Native Hawaiian or Other Pacific Islander

White

Mixed or Multiracial

Some other race, ethnicity or origin

Prefer not to answer

East Asian (China, Japan, Vietnam, Thailand, etc.)

South Asian (India, Pakistan, Nepal, Bangladesh, Sri Lanka, etc.)

Birth Date: / / Home Zip Code: - Zip Suffix Number of Attendees:

Include myself as an attendee:

If you have a coupon, please enter code here (case-sensitive):

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