Registration Information and Sign-Up
Conference for Black Women & Girls
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail Address
*
example@example.com
Phone Number
Age Range
*
Age 12 - 17
18+
Please choose your age range.
18 - 29
30 - 39
40 - 49
50+
Are you a member of Delta Sigma Theta?
Yes
No
Are you a speaker, presenter or moderator at the conference?
Yes
No
Are you a vendor or hosting a resource table?
Yes
No
Do you require a vegetarian meal?
No
Yes
Parent/Guardian Information
Complete only if age range is 12 - 17
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Phone Number
*
Parent/Guardian Email Address
*
example@example.com
How did you hear about the Conference for Black Women and Girls?
Instagram
Facebook
X (formerly known as Twitter)
A member of Delta Sigma Theta
Other (Please specify below)
Notice about Photography and Videography
*
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