Cultural Affinity Registration Form

In this virtual event.

Cultural Centered Affinity groups provides invaluable benefits. The group serves as a resource for individuals who seek further knowledge about intersectionality of race in a Safe & Brave Space to process their thoughts and feelings.

There often lacks an opportunity to have this dialogue, however this is needed.

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Through these efforts, we aim to foster a deeper understanding of race and anti-racism, helping to create a more inclusive and supportive environment.

Groups will meet the 3rd Wednesday of each month for two hours monthly for 5 remaining sessions.

SPACES ARE LIMITED

The identified Affinity Groups available are:

For Black or African American Affiliation (AVAILABLE SPACES)

For Latinx Affiliation (FULL) * For White Affiliation (FULL)

For Arab, Asian, South Asian, Pacific Islander, Native American (FULL)

Multiracial Affiliation (FULL)

Name

First NameLast Name

Age

ProNouns*

She / HerHe / HimThey / ThemOther

Phone Number

Area CodePhone Number

Email

example@example.com

Address

CityState / Province

Postal / Zip Code

Occupation

Caregiver / Early Childhood Provider / ECC / Clinician / Consultant/ Supporter/ Etc.

Company Name

Share Your Location

You do not have to reside in Illinois to participate.

Do you want to register more people?

Where did you hear about this virtual event?

What type of Virtual Event do you wish to attend next time?

Virtual Event Registration Fee

Virtual Event Ticket$ Free

Quantity

Total $0.00

Payment Method

Credit CardPayPalWire Transfer

Please share what you hope to benefit from attending?