Rescheduled Black History Month Program Lecture & Dinner- April 10, 2017-RSVP

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* 1. Name

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* 2. What is your email address

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* 3. Will you be able to attend the Black History Month Event on Monday, April 10, 2017 at 6:00 pm? RSVP by Friday, March 24, 2017.

Yes

No

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* 4. What is your affiliation with CUMC?

Student

Staff

Faculty

Other (please specify)

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* 5. Specify which school you attend or are affiliated with.

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* 6. Do you have any additional dietary restrictions, food allergies, etc.? Please detail.

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* 7. Feel free to note any additional questions or concerns, bringing a guest, questions about the lecture, etc.