This form is used to gather demographic registration information from individuals interested in facilitating on this year's POP Summit. Program dates are October 29-31, 2013. Your personal information will be kept private within our organization and will only be used to engage with you before, during, and after the annual program events. You will also be receiving correspondence from popfacilitators@poweroverprejudice.org.
First Name
Last name
Company/Organization
Email address
Confirm email address
Primary phone
Primary Address
Primary City
Primary State
Primary Zip Code
Emergency Contact
Emergency Phone
STOP STEREOTYPES T-shirt size Small Medium Large Xtra Large 2Xtra Large 3Xtra Large
Are you a new or seasoned volunteer/facilitator? Explain
Select the date(s) you plan to participate as well as your preferred training date. Training is mandatory to participation our program.
Click on your preferred facilitation date: Tues., Oct. 29th Wed., Oct. 30th Thur., Oct. 31th
Click on your preferred facilitator training date:
Contact me about other APC volunteering opportunities
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Anti-Prejudice Consortium 3154 Northside Parkway, N.W. Atlanta, Georgia 30327
info@poweroverprejudice.org
404.745.4549
© 2012 Power Over Prejudice (Anti-Prejudice Consortium)
