Below is the registration form for the Facing History Event at Fordham University on October 12, 2013. Please fill out the form completely. If you have any questions, email us at

Thank you!

* 1. Email:

* 2. First and Last Name:

* 3. Institutional affiliation:

* 4. Position:

* 5. Telephone number:

* 6. Mailing Address (Street, City, State, Zip Code):

* 7. Are you a student-Interested in volunteering for the event? (yes, no, maybe)

* 8. List any questions you would like to be discussed during the community dialogue portion of the program.