Request edit access
JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
2014 Turn Up the BASE Application
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Name
*
Your answer
Address
*
Include street address, city, and zip code
Your answer
Cell Phone or Home Phone
*
Your answer
If cell phone is it ok to text?
Yes
No
Email
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Parent/Guardian/Caregiver Name
*
Your answer
Parent/Guardian/Caregiver Phone
*
Your answer
Turn Up the BASE is a 3 day, 2 night mini-conference on Friday, August 1-Sunday, August 3. It will be held at Point Reyes Hostel in Point Reyes National Seashore (transportation provided). Will you be able to attend the conference in its entirety?
*
Yes
No
Required
If "no", please explain
Your answer
Turn Up the BASE is a conference exclusively for youth of color. Please indicate how you identify:
*
Race (check all that apply)
Latino/a
Black/African American
Asian/Pacific Islander
American Indian
Middle Eastern
Other:
Required
Turn Up the BASE is a conference exclusively for gender marginalized youth (womyn/women or transgender). Please indicate how you identify:
*
Gender
Womyn/Woman
Transgender
Other:
School attending, fall 2014
*
Your answer
Why are you interested in attending the Turn Up the BASE conference?
*
Your answer
What do you think is the biggest issue facing people of color in your community?
*
Your answer
By signing below, I attest to the truthfulness of all information listed on this application and agree to all the above terms and conditions.
*
Please provide your electronic signature by typing your full name
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
