Period Action Day Workshop Registration

Period Action Day Registration

Sign up to participate during the PAD Panel and Workshops. Please submit one form per person.
Parents with one student particpant may submit one form and workshops 1 or 2 and click #3 for yourself, if attending.
Which workshop do you plan to attend?

First Time Period - Period 101: What to Expect and How to PrepareTeens and Period Discussion - Let's Talk Periods: A Safe Space for TeensAfter the Period Perimenopause and Menopause - Navigating Life Changes: Periods, Perimenopause, and You
Name

First NameLast Name
Parent/Guardian Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Student Age
Student Birthdate

MonthDayYear
Student Email
Student Phone Number
Parent/Guardian Email
Parent/Guardian Phone
Grade in School Fall 2024
Where do you go to school?
How did you find out about Period Action Day?
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Period Action Day Registration