Carbondale "At the Table"
Dinner & Dialogue Series
About the Event:
The City of Carbondale will celebrate Women's History Month during the Carbondale "At the Table" Dinner & Dialogue event on March 18th at the Carbondale Civic Center. The theme for this month's discussion is Empowered Women: Breaking Barriers and Building Bridges. Doors will open at 5pm and the program will start at 5:30pm. This event is free and open to the public. Seating is limited. Please fill out the form below to let us know you are coming and tell the host a little bit more about yourself. *Only your name and contact information are required. PLEASE NOTE- The additional demographic information requested is to assist with the grant reporting process. Please email any additional questions to Dianah McGreehan at dmcgreehan@carbondaleil.gov
About the Healing Illinois Initiative
Healing Illinois is a racial healing initiative by the Illinois Department of Human Services (IDHS) in partnership with the Field Foundation of Illinois and the Southern Illinois Community Foundation. The initiative targets community building and engagement designed to strengthen relationships and promote collective healing across communities.
Name
*
First Name
Last Name
Email (or phone number if preferred)
*
example@example.com
Preferred Pronouns
She/Her/Hers
He/Him/His
They/Them/Their
Prefer not to say
Other
Current occupation
(Example: Teacher or Student)
Age
17 years or younger
18-24
25-34
35-44
45-54
55-64
65 or older
Race/Ethnicity
American Indian or Alaska NativeBlack/African American
Asian or Asian American
Black or African American
Hispanic or Latino
Middle Eastern or North African
Native Hawaiian or Pacific Islander
White
Two or more races
Prefer not to say
Would you be interested in serving as a facilitator/volunteer in the future?
Yes
No
Not at this time maybe in the future
Please list any dietary restrictions you have OR note none
If you are bringing any other guests, please indicate the number of guests you are bringing and/or provide their name(s)
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