Registration Form: REI Phase I - September 20-21,2019

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**September workshop currently at capacity for white participants.**

Please submit this questionnaire to indicate your interest in attending the Friday/Saturday September 20-21 REI Phase 1 training. Upon receipt of this form, you will be notified of your registration status.

If you are a person of color, when we receive your response to this questionnaire, you will be offered an equitable seat OR be sent an invoice to complete payment. A limited number of equitable seats are available and are prioritized for People of Color in our Asheville community who are not affiliated with an organization that can pay the registration fee.

This questionnaire is NOT for Alumni registration. If you have attended Phase 1 before, please check your email for a link to alumni registration for this event.

Email Address *

First Name *

Last Name *

Phone Number *

How would a stranger describe your race? *

White

Black or African American

Native American

Asian

Native Hawaiian or Pacific Islander

Other:

Do you describe yourself as Hispanic or Latin(a/o/x)? *

yes

Diversity in gender representation improves the effectiveness of this training. Please share your preferred pronouns. *

She/Her/Hers

He/Him/His

They/Them/Their

Other:

Required

Please list your employer and/or spheres of influence. The training is most effective when there is diverse representation from the community. *

Occasionally there are last minute cancellations and a seat will become available to someone on the waitlist. Please let us know how flexible your schedule is *

I would have to know well in advance to be able to attend the 2 day REI training.

I could possibly adjust my schedule at the last minute and would like to be called if a spot opens up the day before.

I have lots of flexibility and the odds are that if you call me the morning of the training, I would be able to come.

THIS QUESTION ONLY APPLIES TO POC. We offer equitable seats to People of Color who do not have access to funds through an organization they are affiliated with. Having organizations pay for their members' attendance invites them to join in and support racial equity work in our community and allows the limited funding for equitable seats to be used for people who would otherwise have no possibility of attending this training. Please select from the following choices to offer the most accurate description of your situation.

I am affiliated with an organization that can pay for my attendance

I have professional affiliations, but my organization is not prepared to pay for my attendance at this training.

The only way I can attend this training is if I am offered an equitable seat.

I would like to pay for my own seat

Clear selection

Lunch is served both days of the training. Let us know if you have any dietary restrictions. *

Vegetarian

Vegan

Gluten-Free

No Pork

No Restrictions

Other:

Is access to childcare a determining factor in your availability to attend this two day Friday/Saturday training? If yes, we will reach out to get more information from you. *

Yes. I have no options for childcare. I can only attend if childcare is provided.

No. I have other options for childcare or it is not a variable of concern.

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