Hybrid Facilitation Clinic - June 17th, 2024 - 1:00-3:00PM US ET

Registration - Contact Info

First Name *

Middle Name

Last Name *

Personal Pronouns (i.e. he/him, she/her, they/them, etc.)

Email Address *

Phone Number *

Work Phone Number

Address *

Address Line 2

Address Line 3

City *

State *

Postal Code *

Country *

Registration Fee

Our sliding scale honors different abilities to pay and helps us compensate trainers, coordinators, and accessibility providers fairly. The true cost to attend this workshop is $150. If able, we invite you to pay at or above this amount. We ask organizations and individuals with large budgets to pay at the higher rates to keep the workshop accessible to all. We acknowledge the different costs and considerations around your attendance, including childcare/caregiving, time away from paid work, and more, and we offer lower fee options to support your attendance. Choose the fee level that supports you to be in the training!

If you prefer to pay without a credit card, please email info@trainingforchange.org instead of completing this form.

Online Workshop Fee *

$35

$95

$150

$200

$250

$0 (Full Scholarship)

Total

Credit Card

Card Type

Card Number *

Security Code *

Expiration Date *

My billing address is the same as above

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *

Registration - Background Info

Organization/Group You Work With

Area(s) of Work *

Which issues or sectors do you work in? Choose all that apply.

Role(s) *

How best describes the role you play in social change? Choose all that apply.

Racial & Ethnic Identity *

Choose all that apply

Racial & Ethnic Identity (optional)

If selected "other" above or you wish to add more.

Class Background *

How would you describe your class background?

How will you apply what you learn in this training? *

Please let us know if you would like to request any of the following to ensure accessibility (Optional)

Live Closed Captioning (Auto CC is always available)

Sign Language Interpretation (please specify type below)

I will use a screen reader to read slides

Other. Specify below.

Is there anything else we should know about what would make this training more accessible for you? (Optional)

How did you hear about this training? *

Word of Mouth/Friend/Co-worker Newsletter Website Social Media Other

Who did you hear about it from?

If selected "other" above, how did you hear about the training?

Anything else you'd like us to know?