Leadership Series on R.A.C.E. - Registration FEB 22

Leadership Series on R.A.C.E. Registration

Full Name*
First Name Middle Name Last Name
Email*
Company or Organization*
Personal Pronouns*
Position Title*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Work Phone Number*
Based on the nature of our work as a race relations organization we ask individuals to self - identify by providing us with the following information in regards to race/ethnicity.
Race/Ethnicity: Please indicate how you self-identify*
Questions
Why do you wish to participate in the Leadership Series on R.A.C.E.?*
How did you hear about the Leadership Series on R.A.C.E.?*
Commitment Agreement
Candidates are asked to make the following commitments if accepted into the program. To successfully complete the Leadership Series on R.A.C.E., each participant must meet the following requirements:
- Submit your completed application now.
- After the candidate is notified of acceptance, payment must be submitted. Tuition amount: $2,000.00.
- Attend all 6 on-line sessions, held from 10am - 2pm
- Serve as a liaison for your community, in conjunction with other participants of the program.
- Have support from employer for participation in the program.
Will you be able to fulfill this commitment?*
- Yes
- No
I understand the purpose and commitment requirements of the Leadership Series on R.A.C.E.. If selected, I will devote the necessary time and participate fully.
2024 Cohort 7 Dates Coming Soon
After completing this registration form, participants will receive a confirmation email and instructions regarding payment.
Invoice Information
If registrar is different from the listed participants, fill out this information indicating who the invoice should be sent to:
Name
First Last
Title
Email
Company
Address
City State ZIP Code
Phone Number

Leadership Series on R.A.C.E. Registration

Questions

Commitment Agreement

Invoice Information