The Pledge to End Racism · January 2020 Living the Richmond Pledge to End Racism Workshop

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January 2020 Living the Richmond Pledge to End Racism Workshop

Please complete this registration form for the Living the Richmond Pledge to End Racism Workshop on Saturday, January 18 and 25, 2020, to be held at Unitarian Universalist Community Church of Glen Allen, VA.

Contact Information

Name

First Name

Last Name

Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Phone

Congregation/faith community

What church, congregation, meeting, mosque, synagogue, or other faith community, if any, are you a member of/affiliated with? Please use as few acronyms as possible (UU is OK).

Referral

Select all the ways you heard about this workshop

Through church

From a Richmond Pledge postcard

From a friend/family member

Through Facebook

Other

Please tell us other ways you heard about this workshop

Race/Ethnicty

Select the race/ethnicity you primary identify with or select other 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. 1901-1924)

Lucky Few/Silent Generation (b. 1925-1944)

Baby Boomer Generation (b. 1945-1965)

Generation X (b. 1965-1980)

Millennial Generation (b. 1981-2000)

Generation Z (b. 2001 or later)

Payment

The suggested donation includes the workshop, workshop materials, lunch on the first Saturday, and coffee, drinks, and other snacks for both workshop days. If you're able to offer more, it will help spread the Pledge to others. If you're able to offer less, that's fine, too. No one will be turned away based on ability to pay.

Amount

$30 - Requested donation

$20 - Member of a UU congregation

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