Official 2017 Afrikan Black Coalition Conference Application
Welcome to the Official Individual Application. Please submit
If you have any questions please contact MaRonda George at
For those attending with a group, please ensure your ABC Rep/Group leader completes the Group Delegation Registration at by November 30st.
Are you attending with a group?
(i.e., She/Her/Hers, He/Him/His, They/Them/Theirs, Ze/Zhem/Zeirs, etc.)
Your answer
First Name
Your answer
Preferred Name
Your answer
Last Name
Your answer
Your answer
Phone Number
(xxx) xxx-xxxx
Your answer
Your answer
Class Year
Major/Minor (or Intended)
Your answer
Intended Career/Profession
Your answer
Considering your identity (i.e., gender, sexuality, abilities, religion, etc.), who would you feel most comfortable rooming with?
i.e., I am a cis woman and have no preference, my faith is important and I'd like to room with a Muslim man, etc.
Your answer
T-Shirt Size
Dietary Restriction
Do you need any support services?
(i.e., Interpreter, wheel chair accessible, ability services, etc.)
Your answer
Do you foresee any economic barriers to attending the conference?
Are you interested in hosting a workshop?
ABC Conference Workshops Suggestions
Your answer
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