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Portland Black Pride LGBTQ Summitt

Thank you for registering for the 2013 Portland Black Pride LGBTQA Summit. This year’s summit will take place at Portland Community College Cascade Campus on June 22, 2013 from 10:00am-4:30pm. Registration is free for the summit, but you must register to make sure we have enough food for all participants.

Our theme this year is "Eyes Open: Our Past, Our Present, Our Future" to focus on how far we've come as Black LGBTQ people here in Portland and around the world! It is our intention and hope this year to honor those who have paved the way for us to be here, those who are actively making the world a better place, and highlight and empower the next generation of Black LGBTQ leaders to continue to move toward equity, prosperity, and liberation.

If you have any questions about the summit or your registration, please contact Khalil Edwards at portlandblackpride@gmail.com .

You can also check out more information at Portland Black Pride Facebook page

A huge thank you to this years sponsors (so far):
PFLAG Portland/PFLAG Black Chapter,Multnomah County- HIV/AIDS Community Prevention Program,Cascade AIDS Project
PCC Cascade Gay Student Association,
Basic Rights Oregon,Cross Over.

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* 1. What is your first name?

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* 2. What is your last name?

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* 3. What is your age?

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* 4. What city do you live in?

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* 5. Are currently a student? If yes what School? (If not currently enrolled type NA)

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* 6. Do you attend/volunteer/work with any organizations?

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* 7. What is your email address? (We don't share this information)

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* 8. What is the best phone number to reach you at? (Type NA if you don't have one)

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* 9. RACE / ETHNICITY: (You may check more than one.)

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* 10. What sex were you assigned at birth?

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* 11. What is your gender? (Check all that apply)

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* 12. Do you have any dietary restrictions?

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* 13. Do you have any medical/accessibility needs? (Allergies, wheelchair access, interpreter etc?)

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* 14. Please check all that apply below:

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* 15. Conduct & Liability Agreement
I hereby waive all claims arising from my participation, and acknowledge that Cascade AIDS Project and Portland Community Collgee do not have any additional obligations in this regard, nor will they be held liable for damages to self or personal property.

In order to minimize the risks involved I, as a participant, agree to follow the rules and procedures of the Portland Black Pride LGBTQ Summit. I will not possess or consume alcohol or other drugs (other than those prescribed by my doctor, in prescribed amounts) immediately before or during the Portland Black Pride LGBTQ Summit, nor will I engage in disruptive or unsafe behavior that could endanger myself, staff, volunteers or other participants.
By clicking YES, I agree to the statement above and will attend the Portland Black Pride LGBTQ Summit at Portland Community College June 22nd, 2013.

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