Black Maternal and Infant Health Symposium Registration Form

Black Maternal and Infant Health Symposium

Rooted in cultural affirmation and reproductive justice, this symposium explores addressing maternal morbidity and mortality disparities, supporting Black infants through community-based care, policy and systems change for health equity, mental health and holistic wellness, and celebrating joy as a form of resistance and healing
Event Name: Black Maternal and Infant Health Symposium
Date: April 17, 2026
Time: 8:30AM - 3:30PM
Location: Metro United Way, 384 East Broadway, Louisville, Kentucky
Full Name*

First NameLast Name
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Organization / Affiliation*
Professional Role / Title (if applicable)
Do you have any dietary needs or restrictions? (Breakfast and Lunch Provided)
Do you have any accessibility needs or accommodations?
Additional Comments or Special Requests
My Products*
prevnext( X )
Symposium Fee
$25.00 Quantity
Item subtotal:$0.00

Total

$0.00
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Should be Empty: