Weeklong Training July 2018 Chicago - Registration
Please register below for the Weeklong Training Sunday July 15 through Saturday, July 21, 2018. This will take place at DePaul University in Chicago, Illinois.
First Name *
Your answer
Last Name *
Your answer
E-mail Address *
Your answer
Phone Number (XXX) XXX-XXXX *
Your answer
City *
Your answer
State *
Organization *
If OTHER, please add your organization name.
Your answer
Position
Your answer
Do you have any special dietary needs? *
If 'OTHER' Please explain:
Your answer
What is your role at this training? *
Required
Lodging Options *
Is there anyone you would like to request to room with? *
If 'YES' Please list their name below:
Your answer
When will you check in for lodging? *
When will you check out? *
Everyone at the training needs a mentor. The name of my mentor is:
Your answer
My mentor's email address is:
Your answer
My mentor's phone number is:
Your answer
Please let us know which pronouns you like others to use when referring to you: *
If Other, please state your preferred pronouns:
Your answer
Racial Identity *
How would you identify your current economic class? *
Thank you for completing your registration form! Please click on submit. You can pay for your fees at the following link: https://secure.actblue.com/donate/weeklongiljuly2018. You can also download all the reading materials from this link: https://drive.google.com/open?id=1y-NR3gCgW7rAWkHFJKKa3kaIemuOtZ8y We will be sending a Logistics Memo with more details closer to the date soon.
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