Chavis Day Registration
Name
*
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Gender
*
Please Select
Male
Female
Non-Binary
Prefer Not to Answer
Registration Type
*
Please Select
Single Person
Family
Additional Attendees
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Preferred Method of Communication
*
Please Select
Email
Text
Mail
How did you hear about this event? (Select all that apply)
*
Word of mouth
Social Media
Community Center
Radio
TV
Flyer
Other
Which of these groups would you say best represents your race/ethnicity?
*
Please Select
Asian or Asian American
Black or African American
Native American or Alaska Native
Native Hawaiian or Pacific Islander
White
Hispanic or Latino
Please select your age group:
*
Please Select
Children (0-12)
Teens (13-18)
Young Adults (19-30)
Adults (31-54)
Seniors (55+)
Are you a Chavis Day Volunteer?
*
Yes
No
Are you a member of Delta Sigma Theta Sorority, Inc?
*
Yes
No
Thank you for participating!
Submit
Should be Empty: