New Orleans Regional Registration
Workshop for which you would like to register *
Name *
If you are registering a group, please complete the Group question at the conclusion of this form.
Your answer
Organization(s)
Your answer
Home Address *
Your answer
City/State/Zip *
Your answer
Phone Number *
Your answer
Email Address *
Your answer
Do you have any dietary restrictions?
We will do our best to accommodate you, and call you to follow-up if we are unable to do so.
Your answer
How do you identify racially?
(Answer not required but would help us to work towards a diverse group of participants)
Your answer
If you are registering a group of people, please list each person's name, email address, any dietary restrictions, and what their race is.
Person's Name - Person's Email - Vegetarian (Yes / No) - Race
Your answer
Please provide a brief description of how you work in your community and/or your connection to the New Orleans community. *
Your answer
How did you hear about the workshop?
Your answer
PISAB wants to ensure that no individual is denied services, or otherwise excluded. If you need assistance, services, or have any other requests, please indicate below or call us at 504-301-9292.
Your answer
Registration Rate *
Please select the appropriate rate that you plan to pay. If you would like to apply for a scholarship check that box as well.
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