Beloved Community Week Participant Registration

Event Selection and Participant Information

We are honored to offer several opportunities to celebrate Beloved Community Week 2025 and the 9th Annual National Day of Racial Healing! All events are free and open to the public.

Question Title

* 1. I plan to attend the following events:

Tuesday, January 21 - Racial Healing Circle (11am - 1pm)

Wednesday, January 22 - Virtual Screening of The 13th (6-9pm)

Thursday, January 23 - Racial Healing Circle (6-8pm)

Question Title

* 2. Please provide your contact information so that your registration can be confirmed with additional details for the events you selected.

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

Question Title

* 3. Demographic Information (this information will help us with planning our time together and is optional)

RACE/ETHNICITY

American Indian or Alaska Native

Asian or Asian American

Black or African American

Hispanic or Latino

Middle Eastern or North African

Native Hawaiian or other Pacific Islander

White

Another race

Prefer not to disclose

Question Title

* 4. AGE

Under 18

18-24

25-34

35-44

45-54

55-64

65+

Prefer not to disclose

Question Title

* 5. GENDER

Non-Binary

Trans-Female

Cis-Female

Trans-Male

Cis-Male

No Gender

Prefer not to disclose

Please list if not above:

Beloved Community Week Participant Registration

Event Selection and Participant Information

Question Title

* 1. I plan to attend the following events:

Question Title

* 2. Please provide your contact information so that your registration can be confirmed with additional details for the events you selected.

Question Title

* 3. Demographic Information (this information will help us with planning our time together and is optional)

RACE/ETHNICITY

Question Title

* 4. AGE

Question Title

* 5. GENDER

Question Title

* 6. Do you have any food allergies or dietary restrictions?

Question Title

* 7. Are there accommodations that can support your participation? We may not be able to meet every need but we will do our best.

Beloved Community Week Participant Registration

Event Selection and Participant Information

Question Title

* 1. I plan to attend the following events:

Question Title

* 2. Please provide your contact information so that your registration can be confirmed with additional details for the events you selected.

Question Title

* 3. Demographic Information (this information will help us with planning our time together and is optional)RACE/ETHNICITY

Question Title

* 4. AGE

Question Title

* 5. GENDER

Question Title

* 6. Do you have any food allergies or dietary restrictions?

Question Title

* 7. Are there accommodations that can support your participation? We may not be able to meet every need but we will do our best.

* 3. Demographic Information (this information will help us with planning our time together and is optional)

RACE/ETHNICITY