EBG Fall Conference Online Registration
Please fill in the form below.
Full Name
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First Name
Last Name
Student or Adult?
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Student
Adult
If student, which school do you attend and grade?
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Gender?
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Female
Male
Non-Binary
Age?
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Zip Code?
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Phone Number?
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Emergency Contact? (Include name, phone number & relationship)
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First time attending a EBG conference?
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Yes
No
Any Food Allergy or Dietary Need?
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T-Shirt size?
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Please Select
S
M
L
XL
2XL
3XL
4XL
5XL
ADULT SESSION 1 10:50-11:45 (If you're not 18 or over, mark N/A)
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Please Select
Petals and Prayers with Zakiya (Herbal baths, teas, oils) (Ages 18-24)
Overview of Juv. Justice Reform Act(Ages 25 and up)
N/A I'm under age 18
ADULT SESSION 2 1:45-2:45 (If you are not 18 or over, mark N/A
*
Please Select
Build-A-Boss with Ashley (Ages 18-24)
Police Free Schools (Ages 25 and up)
N/A I'm under age 18
ADULT SESSION 3 3:05-4:05 (If you are not 18, mark N/A)
*
Please Select
Painting with Valencia (Age 25 and Up)
African Dance with Queen T. (Age 18-24)
N/A I'm under age 18
ELEMENTARY SESSIONS 1-2-3 (If you're not registering for an elementary schooler, mark N/A)
*
Please Select
Black Girls' Clubhouse
N/A: I'm not in elementary school.
MIDDLE SCHOOL SESSION 1 10:50-11:45 (If you're not registering for a middle schooler, mark N/A)
*
Please Select
Weight of Words with Quinn Hayes
African Dance with Queen T.
N/A: I'm not in middle school
MIDDLE SCHOOL SESSION 2 1:45-2:45 (If you're not registering for a middle schooler, mark N/A)
*
Please Select
Weight of Words with Quinn Hayes
Painting with Valencia
N/A: I'm not in middle school.
MIDDLE SCHOOL SESSION 3 3:05-4:05 (If you're not registering for a middle schooler, mark N/A)
*
Please Select
Weight of Words with Quinn Hayes
I Love My Brown Skin with Bri Smalls
N/A I'm not in middle school
HIGH SCHOOL SESSION 1 10:50-11:45 (If you're not in high school, mark N/A)
*
Please Select
Painting with Valencia
I Love My Brown Skin with Bri Smalls
N/A I'm not in high school
HIGH SCHOOL SESSION 2 1:45-2:45 (If you're not in high school, mark N/A)
*
Please Select
African Dance with Queen T.
I Love My Brown Skin with Bri Smalls
N/A I'm not in high school
HIGH SCHOOL SESSION 3 3:05-4:05 (If you're not in high school, mark N/A)
*
Please Select
Petals and Prayers with Zakiya (Herbal baths, teas, oils)
Police Free Schools
N/A I'm not in high school
E-mail?
*
example@example.com
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