Save Our Community Registration
Friday October 31, 2025 9am-3pm
Please be aware that you will be asked to fill out a second registration for specific breakout sessions once they have been selected and scheduled. Also please be aware that you will be asked to fill out a post- event survey as well.
Name
*
First Name
Last Name
Organization and Role (if applicable)
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please provide your gender. This information is requested by our grant providers
*
Non-binary
Female
Male
Prefer not to answer
Please provide your age. This information is requested by our grant providers.
*
10-20
20-30
30-40
40-50
50-60
60-70
70-80
prefer not to answer
What is your racial or ethnic identity? This information is requested by our grant providers.
*
African-American
African/ Afro-Caribbean
Latinx
Native America/ Alaskan Native
Asian/ South Asian
AAPI
White
Other/ Prefer not to answer
What is your highest level of education? This information is requested by our grant providers.
*
High School
Community College
Bachelors
Masters
Doctorate
Certification/ Trade School
Other
What annual income range do you belong to? This information is requested by our grant providers.
*
under $30K
$30-40K
$40-50K
$50-60K
$60-70K
more than $70K
Have you been impacted directly or indirectly by community and/ or domestic violence?
*
Yes
No
If you have been impacted, please tell us how if you are comfortable doing so.
*
What resources, if any, dealing with community and/or domestic violence are you familiar with?
*
Are you currently involved in violence prevention or community safety efforts?
*
Not Involved
Somewhat Involved
Very Involved
If you are involved in violence prevent or community safety efforts, please provide more details.
*
How would you rate your current understanding of the violence crisis in Kansas City?
*
Very Low
Low
Moderate
High
Very High
In your opinion, what is the single largest contributor to violence within our community?
*
What types of breakout sessions would you be most interested in attending?
*
Financial Planning
Mental Health
Faith
Domestic Abuse
Self-Esteem
Self Defense
Available Resources/ community Outreach
Identifying Red Flags and Toxic Relationships
Grief
Healthy Masculinity
Understanding the Law
Dealing with Police
Other
Do you have any other topics you would like us to consider offering as a breakout session? If so, please list below.
*
Please list any dietary restrictions and food allergies
*
Will you need an interpreter of any kind?
*
Please let us know of any additional accommodations you require.
*
I consent to the use of my image, voice, or likeness in photographs, videos, or other media for event-related purposes.
*
Yes
No
Submit
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