Microaggression Registration Form
Exploring the impact of everyday slights and insults: Microaggressions in the workplace and classroom

3:00 - 5:00 pm
Zoom Meeting
September 28, 2021
Email Address *
First Name *
Last Name *
Mailing Address
Age *
Gender *
Ethnicity (This information is collected for grant purposes) *
Statement A: I understand that by registering for this workshop I am committing to:
1. Attending the online meeting (or emailing the hosts at ywcaoffice@ywcaak.org if I need to cancel).

2. Not recording audio or video of the meeting.

3. Respecting confidentiality and not retelling stories told by others without their permission.

4. Listening respectfully to others but also listening to my own needs and opting out of any listening or speaking as needed.

5. Never selling or otherwise using this workshop format or related materials for profit.
Please note your response after reading Statement A (above): *
Statement B: I understand that sharing and listening to stories can sometimes trigger overwhelming feelings. While listening and sharing, I will try to pay attention to my own needs and step away or pass whenever needed. I also understand that all sharing is optional.
Please note your response after reading Statement B (above) *
Thank you for completing this form. Please click to submit, below. If you have any questions you can contact us at (907) 644-9600 or email ywcaoffice@ywcaak.org
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