2024 Fall Session - Ms Jackie Group event registration

First Name *

Last Name *

Phone *

Email *

Address *

City *

Zip *

Country *

Please tell us how you identify your race/ethnicity (check all that apply)? *

Please type your race

How did you hear about this class?

Have you taken Black History for a New Day? *

How would you describe your level of understanding and comfort with racial justice and Black history? *

Please rank how comfortable you are with technology? (1 -not comfortable, 5 - comfortable) *

What other trainings or classes have you taken related to racial justice and Black history?

Photo Release *

As part of registering you hereby grant permission to use photographs and videos of you taken in publications news releases online and other communications related to the mission of Nehemiah. Thank you!
NO, thank you.

Company/Organization Name (if applicable)

Individual registration