Welcome. Be Our Guest!
Registration is Complimentary
I would like to register for the ...
*
Please Select
Virtual Experience
Due to capacity limits, everyone will be pre-registered to attend virtually.
Do you have additional guests who will join you at the Conference?
*
Please Select
Yes
No
You can add up to 10 guests to attend the virtual conference experience.
Name
*
First Name
Last Name
Role/Title
*
Organization
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Are you a...
*
Please Select
Educator
Community member
Organizers/advocate
Policy maker
Activist
Artist
Writer
Legal scholar
Racial justice advocate
Communication specialist
Other
I grant the Bob Moses Conference permission to capture my image and likeness in photographs, video recordings, or any other media (collectively “Images”). I acknowledge that the Bob Moses Conference will own such Images and further grant the Bob Moses Conference permission to copyright, display, publish, distribute, use, modify, print and reprint such Images for any lawful purpose related to the Bob Moses Conference mission, including without limitation, publications, brochures, web site images, or other electronic displays and transmissions thereof. I further waive any right to inspect or approve the use of the Image by the Bob Moses Conference prior to its use. I release and hold the Bob Moses Conference harmless from any and all liability arising out of the use of the Images in any manner or media whatsoever, and waive any and all claims and causes of action relating to use of the Images, including without limitation, claims for invasion of privacy rights or publicity.
*
Yes, I agree
No, I do not grant permission
Please add guest information for up to 10 guests:
Please share any questions or comments for the event organizers:
Thank you for donating to support the activities of the Bob Moses Fund for Education and Organizing. We are so grateful for your support, a receipt for your generous gift will be sent to your email.
prev
next
( X )
Count Me In - Add a Donation of $25
Proceeds Benefit the Bob Moses Fund. Thank You!
$
25.00
Quantity
1
2
3
4
5
6
7
8
9
10
Count Me In - Add a Donation of $50
Proceeds Benefit the Bob Moses Fund. Thank You!
$
50.00
Quantity
1
2
3
4
5
6
7
8
9
10
Count Me In - Add a Donation of $100
Proceeds Benefit the Bob Moses Fund. Thank You!
$
100.00
Quantity
1
2
3
4
5
6
7
8
9
10
Count Me In - Add a Donation of $150
Proceeds Benefit the Bob Moses Fund. Thank You!
$
150.00
Quantity
1
2
3
4
5
6
7
8
9
10
Count Me In - Add a Donation of $200
Proceeds Benefit the Bob Moses Fund. Thank You!
$
200.00
Quantity
1
2
3
4
5
6
7
8
9
10
Count Me In - Add a Donation of $250
Proceeds Benefit the Bob Moses Fund. Thank You!
$
250.00
Quantity
1
2
3
4
5
6
7
8
9
10
Donation Payment Information. Complete this payment section ONLY if you are making a donation.
Thank you for supporting the Bob Moses Fund!
Pay with Credit Card
Submit
Should be Empty: