2024 Fall In-Person Living the Richmond Pledge to End Racism Workshop

Please complete this registration form for the Living the Pledge to End Racism Workshop to be held in-person at Unitarian Universalist Community Church Glen Allen on Saturdays, September 21 & October 5, 9:00am - 4:30pm EDT. You must plan to attend both days.

Workshop materials, beverages, and snacks will be provided, though you will need to bring your own lunch. Registration is $60 (scholarship assistance is available).

Contact Information

Name *

First Name

Last Name

Email *

Verify Email *

Address *

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Phone

Demographic Data

We use demographic data to aid us in creating diverse small groups. Please answer as you feel comfortable.

Congregation/faith community/organization

If you are affiliated with a faith community, congregation, organization, school, college, or university, please list it here.

People You Know

To help us keep our small groups balanced, please list any family members/friends who are attending this workshop with you.

Race/Ethnicty

Select the race/ethnicity you primary identify with or select "another options" and enter your own

African American/Black/African Descent

Asian/Pacific Islander

Hispanic/Latino

Multiracial

Native American/Alaska Native

White

Another option

Race/ethnicity option

Generation *

What is your generation?

WWII Generation (b. 1901-1928)

Lucky Few/Silent Generation (b. 1928-1945)

Baby Boomer Generation (b. 1946-1964)

Generation X (b. 1965-1980)

Millennial Generation (b. 1981-1996)

Generation Z (b. 1997-2012)

Alpha Generation (b. 2013-)

I prefer not to answer this question

Gender

To which gender do you most identify?

Female

Male

Other (please specify)

Other Gender

Referral

Select all the ways you heard about this workshop

Through church

From a Richmond Pledge postcard/flyer

From a friend/family member

Through Facebook

Through an online search

Other

Please tell us other ways you heard about this workshop

Request Childcare

If you need childcare, please include ages of children below. Otherwise, leave blank.

Childcare needs

Children ages

Payment

While our workshop leaders and small group facilitators all donate their time to make these workshops happen, there are still costs associated with developing and promoting the Pledge and workshop. Please offer what you can to help us spread the Pledge to others, knowing that no one will be turned away based on ability to pay. Select an amount or fill in an amount of your choosing.

Amount *

$60 - Suggested donation

$75 - Pay-it-forward donation

$30 - Reduced registration

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