The Whole Story: A Decolonial Cross-Cultural Day Institute & BIPOC Scholarship Fundraiser Registration Form
November 14, 2019
12:00 PM to 6:00 PM at:
Missouri Southern State University
Billingsly Student Center
3rd Floor, Connor Ballroom
3950 Newman Rd, Joplin, MO 64801
6:30 PM to end at:
715 E Broadway St, Joplin, MO 64801
Please contact, co-found and director Dr. Rebecca Mouser (
) with questions.
Who is attending this event? Please fill out a registration form for each registration payment and not for each person attending. If they are under 18 please include an emergency contact name + number.
Break out sessions schedule.
Please name your two choices for the 1:15-2:05 time slot here, ranking them 1 and 2. If you are registering for more than one person, please include their name before their selections.
Please name your two choices for the 2:15-3:05 time slot here, ranking them 1 and 2. If you are registering for more than one person, please include their name before their selections.
Please name your two choices for the 3:15-4:05 time slot here, ranking them 1 and 2. If you are registering for more than one person, please include their name before their selections.
Will you be attending the Scholarship Fundraiser Event at Bookhouse Cinema (6:30 PM onward)?
If you're excited about meeting Adib Khorram and want him to sign your book at the Meet and Greet, please be sure to buy one in advance. You can buy a book online at amazon:
or anywhere else books are sold!
I bought a book!
Registration Payment Options: 1) $10/per person by check payable to Missouri Southern Foundation with "The Whole Story" in the note line (mailed to: Dr. Rebecca Mouser, Department of English, Kuhn Hall 203D, 3950 Newman Rd, Joplin, MO 64801) or 2) $10/per person online directly to
where you follow the directions in the below image. In this question, please tell us how you paid, and tell us the name of the person making the payment if it is different than the persons attending.
If you would like to donate to the scholarship fundraiser in any amount, you are welcome to do so along with your registration amount. Donations are tax-deductible and will go to fund two new scholarships for Black, Indigenous and Students of Color in the English Department at MSSU.
A copy of your responses will be emailed to the address you provided.
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