Undoing Racism in Sarasota - Registration Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Thank you for your interest in the Undoing Racism workshop from May 21-23, 2022. Please fill out the information below to let us know that you're interested.

WORKSHOP TIMES:
Saturday, May 21, 12-9pm
Sunday, May 22, 1-8pm
Monday, May 23, 4-9pm

WORKSHOP LOCATION:
Sarasota Friends Meeting House; 3139 57th Street; Sarasota, FL 34243
(NW Corner of Lockwood Ridge Road at 57th Street)

The cost of the workshop is $350 per person, and we are committed to having members of our community participate regardless of their ability to pay - we have a number of scholarships available.

You will have the ability to pay online or via check made out the the Peace Education and Action Center. We will contact you on or after February 10th with more information on how to pay for the workshop.

Email *

Please note: The scope of this issue makes your commitment to attend the entire weekend essential to the success of this workshop. The workshop is limited to 35 participants.

Name *

Which faith community do you identify with? *

Age *

Ethnicity/race/nationality *

Gender *

Address, including city *

Telephone #

Email address

Please briefly describe your current work in the community (paid or otherwise) and how it connects you to your commitment to undoing racism. *

We will provide free childcare during the workshop. Will you need it? *

Yes

Maybe

If you will need it, how many children will you bring, and what are their ages?

If you will need it, what days and times will you need it?

Do you need financial assistance for the workshop fee ($350)? If so, please indicate how much you will need:

This space is wheelchair accessible, and we will provide seating for everyone. Are there any other accommodations that you would like or need us to have available?

We will be providing a few meals during the course of the workshop. Please let us know if you (and your children, if applicable) have any dietary needs we need to consider.

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms