Event Registration Form

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* 1. Name

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* 2. Email

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* 3. Phone (optional)

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* 4. Job title

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* 5. Are you a member? (Please select all that apply.)

I am a member of Black Men On The Hill

I am a member of Senate Black Legislative Staff Caucus

I would like to learn more information about these staff organizations

I am a member of both organizations

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* 6. Please provide a question you may have for senior staffers
(questions will remain anonymous)

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* 7. Who do you work for?