WE WIN Together Racial Justice Community Registration

Please fill out the form below to join our Racial Justice Community.

Additional information about our community can be found here.

Question Title

* 1. Please fill out your contact information

Name *

Organization/Affiliation *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code

Country *

Email Address *

Phone Number

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* 2. Are you joining as part of a team from you community or organization? If so, please list the name of your team, organization or community. If not, just write no.

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* 3. Which affinity groups are you a part of?

Youth

Stakeholder Health

Well Being Alliance

WIN Core Team

Other (please specify)

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* 4. Would having a scholarship make it much easier to participate in this community? As part of our commitment to equity, we have tried to make it possible for anyone to be able to participate. Just let us know and answer a few questions about what you will contribute to this community on the next page.

Yes

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* 5. Please select your membership level.
Prices include transaction fees.

Fall 2020: Groundbreakers (focus on exploring one's individual race equity journey, building skills for dialogue about race) - $309 USD

Fall 2020: Pacesetters (focus on policy and systems change at the organizational or community level) - $309 USD

Fall 2020: Both - $515 USD

I need a scholarship or discount to participate (choose this option) - $0 USD

You will pay at the end of this survey.

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* 6. If interested in dedicated coaching, please select your desired number of hours.

Clear

i We adjusted the number you entered based on the slider’s scale.

WE WIN Together Racial Justice Community Registration

Question Title

* 1. Please fill out your contact information

Question Title

* 2. Are you joining as part of a team from you community or organization? If so, please list the name of your team, organization or community. If not, just write no.

Question Title

* 3. Which affinity groups are you a part of?

Question Title

Question Title

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* 5. Please select your membership level.Prices include transaction fees.

Question Title

* 6. If interested in dedicated coaching, please select your desired number of hours.

* 5. Please select your membership level.
Prices include transaction fees.