Individual Registration

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Individual Registration

* Indicates required field

Name/nombre *

First

Last

Email/correo electronico *

We will only send you participant information about the neighborhood project. We will not share your contact information with anyone.

Phone Number/numero de teléfono *

We will only text or call you about participant information regarding the neighborhood project. We will not share your contact information with anyone.

Facebook username/nombre de usuario *

This enables us to invite you to a facebook group which will contain the most current information during the course of the training.

Dietary Restrictions/restricciones de dieta *

Will you need childcare?/ Necesitas cuidado de niños? *

Yes/Si No/no

List names, ages, and dietary restrictions of any children. (Or if no children attending, write "none")./ Lista las nombres, edades y restricciones de dieta de sus niños. (O, si no tiene niños, pone "no aplica" *

Would you or anyone in your group benefit from translation services?/ ¿Alguien de su grupo se beneficiaría de los servicios de traducción? *

Yes, please./Si, por favor No./no

If yes, what is the primary language of those needing translation?/ En que idioma necesitas traduccion? *

How would you like to pay the $20 registration fee (scholarships available)?/Como le gustaria pagar el registro de $20? (Hay becas) *

I'd like to pay now, please! (Just follow the instructions on the confirmation page)./ Quiero pagar ahora del internet. I'd like to pay at the event. (We can take cash or check)./Quiero pagar el primer noche del evento. Scholarships are available? Yes please!/ Hay becas? Quiero informaccion por favor. I am coming as a part of a group that is covering my registration./ Estoy parte de una organizacion que esta pagando mi cuota.

We are fortunate to have generous donors who have covered the cost of our speakers, translators, childcare, and administrative costs, because they want to invest in the power of our community! The registration fee serves to supplement the cost of dinner for our participants.

Are you coming as a part of an organization, institution, or group? Please write the name of the group here./ Estas veniendo como parte de un grupo o organizacion? Favor de poner el nombre del grupo aqui. *

Are you able to attend all sessions? (Check all that apply)/ Puedes asistir a todas las sesiones? Marque todo lo que corresponda. *

Yes!/ Si! I will be absent for Session 1/ Voy a estar ausente la primera sesion.. I will be absent for Session 2/Voy a estar ausente la segunda semana. I will be absent for Session 3/ Voy a estar ausente la tercera semana. I will be absent for Session 4/Voy a estar ausente la cuarta semana.

I would like you to make it easy for me to invite others in my community or organization. *

Yes! Please send me a flyer that I can post or email to others. Yes! Please tag me on social media posts so I can share easily without added work! No, thanks!

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