IAAHS Community History Tables Pre-Registration Form

IAAHS Community History Tables Registration

Register to participate in the Iberia African American Historical Society's community conversations about local African American history.
Personal Information

Please provide your personal details for registration.
Full Name*

First NameLast Name
Mailing Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
City*
State*
ZIP Code*
Contact Details

How can we reach you?
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Where do you live? (Community)
Interest in Local History

Let us know your areas of interest.
Family history / genealogyLocal community historyChurches and religious historyEducation and schoolsSugarcane industry and labor historyCivil rights / segregation era historyOther
If you selected "Other" above, please specify your interest:
Conversation Guidelines Acknowledgment

Please review and acknowledge our conversation guidelines.
Listen respectfully to othersAllow everyone an opportunity to speakParticipate in a spirit of curiosity and learningTreat all participants with respect
Optional History Question

Share your interests to help us shape our conversations.
Is there a person, place, or story from Iberia Parish history that you would like to learn more about? (Optional)
Session Date

MonthDayYear
Date
Session Location
Should be Empty:

IAAHS Community History Tables Registration