Roundtable Discussion: Anti-Blackness and Systemic Racism in Rural West Tennessee

Event Registration Form

Saturday, September 28, 2024

10:00 AM – 3:00 PM

Lane College

816 N Hays Ave, Jackson, TN 38301

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1. Name (Required.)

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2. Company/Organization

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3. Address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Roundtable Discussion: Anti-Blackness and Systemic Racism in Rural West Tennessee

Event Registration Form

Question Title

1. Name (Required.)

Question Title

2. Company/Organization

Question Title

3. Address

Question Title

4. County (Required.)

Question Title

5. Email (Required.)

Question Title

6. Phone (optional)

Question Title

7. Do you have any dietary restrictions?

Question Title

8. How did you hear about the event?

Question Title

9. What do you hope to learn from this event?

Roundtable Discussion: Anti-Blackness and Systemic Racism in Rural West Tennessee

Event Registration Form

Question Title

* 1. Name (Required.)

Question Title

* 2. Company/Organization

Question Title

* 3. Address

Question Title

* 4. County (Required.)

Question Title

* 5. Email (Required.)

Question Title

* 6. Phone (optional)

Question Title

* 7. Do you have any dietary restrictions?

Question Title

* 8. How did you hear about the event?

Question Title

* 9. What do you hope to learn from this event?

1. Name (Required.)

2. Company/Organization

3. Address

4. County (Required.)

5. Email (Required.)

6. Phone (optional)

7. Do you have any dietary restrictions?

8. How did you hear about the event?

9. What do you hope to learn from this event?