Living Legacy Project · 2024 November Alabama LLP Pre-Registration Information Form

2024 November Alabama LLP Pre-Registration Information Form - November 13-17, 2024

Please complete one LLP Pre-Registration Information form for each person who will be traveling.

NOTE: After you've completed this form, you must also register with our tour partner, Educational Travel Adventures (ETA) and submit a deposit. You will receive instructions for how to do this when you submit this form.

Contact Information

Enter your first and last name as you'd like it to appear on your name tag. You'll enter your full legal name when you complete the registration form with ETA.

Name

Prefix

First Name

Last Name

Suffix

Verify Email

Cell Phone

Enter a cell phone where we can reach you on the trip

Mailing Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Privacy

We create a roster to share with all the participants on the Pilgrimage with your name (as listed on this form), home city and state, cell phone, email address, and pronouns. If you DO NOT want us to share specific information about you on the roster, please select it below.

City

State

Cell phone number

Email address

Pronouns

Goals

In just a few words, what do you most hope to gain from the Living Legacy Pilgrimage experience?

Identity Information

This information is optional but helps us get a sense of who will be joining us so we can provide the best service to you.

Date of Birth

(mm/dd/yyyy)

Faith community

Do you belong to a church, congregation, synagogue, mosque, meeting, or other faith community?

Yes

The name of my congregation/faith community is:

No acronyms please

Race/Ethnicity

Check all that apply.

African Descent

Asian or Pacific Islander

Bi/multi-racial

Latino/a/x

Middle Eastern

Native American or First Nations

European or Caucasian

Not Listed

Prefer Not to Disclose

Race/ethnicity information

The pronouns I would like others to use for me are:

She, her, hers

He, him, his

They, them, theirs (in the plural or singular)

Ze or zie

Hir/hirs

Other pronouns

I don't use pronouns. Please use my name.

List pronouns you use here.

Lodging and Roommate Preference

Number in Room

How many people will be sharing a room (including you)?

The bed type I would like is:

a king bed

two queen beds

no preference

I prefer a roommate(s):

who identifies as the same gender as I do

who is of any gender identity

I already know my roommate(s)

I don't want a roommate.

My primary gender identity is:

Female

Male

Transgender

Genderqueer

Nonbinary

Gender non-conforming

Other gender identity

I prefer not to answer

My preferred roommate is:

Type full first and last name of each preferred roommate

Transportation

What method of transportation do you plan to use to get to our starting city?

Airplane

Train

Bus

Car

Other

Pilgrimage Scholarship Fund Donation

We encourage those who are privileged by means of their color or economic advantage to contribute a full or partial registration to our Living Legacy Project Pilgrimage Scholarship Fund. This amount will allow a person whose life has been impacted by color discrimination, by the legacy of enslavement and/or racism, or through economic disenfranchisement to fully participate in the pilgrimage. All of us will be richer for everyone's participation.

The value of this Living Legacy Pilgrimage is priceless. By donating toward the cost of the trip fr someone else, you have an opportunity to take concrete action toward healing the wounds of racism.

ONLY SELECT AN AMOUNT IN THE SECTION BELOW IF YOU WANT TO MAKE AN ADDITIONAL DONATION OVER AND ABOVE YOUR REGISTRATION FEE (you'll pay your registration fee when you register with ETA).

Amount

$1,500

$1,000

$500

$250

$100

Donation Schedule

Add 3% to my total amount to help cover the payment processing fees