Introduction to Analysis of Racism Individual Information
Thank you for your interest in the Introduction to the Analysis or Racism Workshop.  Information that you provide will be used only for the purpose of improving your experience at this event.  This information may be shared with the workshop organizers, leaders and Tall Oaks staff only.  You will not be subscribed to any lists.
 
1.
Please let us know a little bit about you.

First Name:
Last Name:
Work Phone:
Email Address:
emailaddress@xyz.com
Address 1:
Address 2:
City:
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(US/Canada):
Postal Code:
Country:
Cell Phone:

2.

Whom shall we contact in the event of an emergency?

 

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3.

Please list any special needs, food allergies, etc. 

 

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4.

If you are with a church organization, please tell us the name of the organization and your title and role.

 

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