Please complete this form to request information about the availability and services of The Privilege Institute and/or Dr. Eddie Moore Jr. Please allow 3-5 business days for response.
Name of Organization
First and Last Name of Requester
Title / Department
What service are you requesting?
Permission to use the 21 Day Racial Equity Habit Building Resources
Are you requesting services from:
Dr. Eddie Moore Jr / America & Moore LLC
The Privilege Institute (501c3 / Non-Profit)
Unsure / N/A
In Person Event
Virtual - Live Event (not recorded or shared on social media)
Virtual - Live Event (recorded and/or shared on social media)
Mix of in-person and virtual
One time event
List Date(s)/Time(s) requested
What is your budget?
Who is your audience?
Brief description of request
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