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2018 Alabama Living Legacy Pilgrimage Registration

Please complete one registration form for each person who will be traveling.

Contact Information
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Prefix
First Name
Last Name
Suffix

Please include your full first and last name as you'd like it to appear on your name tag
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Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country

Do you belong to a church, congregation, synagogue, mosque or other faith community?
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No acronyms please, except for UU
Identity and Roommate Information

Type full first and last name

It's important to have your birthdate in order to secure the best rates and to plan age-appropriate activities.
Medical/Emergency Needs and Information
Please note and describe any additional support you may need during the LLP-YCRP
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Identify any life-threatening allergies, including food-allergies

Note any medical needs you have and any special accommodations you need in your hotel rooms
Southern cooking is not always accommodating to dietary preferences but we make every effort to accommodate special dietary restrictions based on health needs. Please check all the types of foods you WILL NOT/CANNOT eat under any circumstances. For example, if you're vegetarian and gluton-free, check "Beef," "Pork," "Chicken," "Fish," "Shellfish," and "Gluton." If you're an omnivore -- in other words, you have no dietary restrictions -- check "I have no dietary restrictions." I WILL NOT eat:
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Photo/Video consent and Referral information
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How did you hear about this Alabama Living Legacy Pilgrimage. Please check all that apply.

In what other way(s), did you hear about the 2018 Alabama Living Legacy Pilgrimage?
Payment Information
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Scholarship Fund Donation

The value of this Living Legacy Pilgrimage is priceless. The cost of the trip is an opportunity for individuals to take a concrete action toward healing the wounds of racism.

We encourage participants who are privileged by means of their color to contribute full or partial payment to our Living Legacy Project IRA account (Individual Reparation Account). This amount will allow a second person whose life has been impacted by color discrimination or by the legacy of enslavement and/or racism to fully participate in the pilgrimage. All of us will be richer for these reparations.

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