Continuing Revolution 2022 Registration

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Continuing Revolution 2022 Registration - 1

This is the first step in a multi-step registration process. The next step is a form that deals with more logistical aspects of your participation like on campus or online part-time or full-time attendance and payment.

***You can find the link to the next steps for registration or financial aid in the final section of this form, or in your confirmation email. Links are also on the Continuing Revolution webpage. Your registration is not final until you have completed both portions.***

If you are not able to complete the registration at this time, please email Co-Coordinator Lina Blount (lblount@pendlehill.org) to discuss next steps.

Email *

First Names *

Last Name *

Preferred Name, if different than first name

City, State, and Country *

Phone number *

Date of Birth *

TTTT

Pronouns

Ethnicity *

African Descent (Black)

Asian Descent

Caucasian/European Descent

Hispanic/Latinx

Middle Eastern Descent

Native American / Aboriginal Descent

Pacific Islander

Multi-ethnicities

Other

Wajib diisi

We recognize the limitations of a demographic survey and provide this space for you to describe your identity (racial, ethnic, gender, sexual orientation, and other identities) as desired in your own words. *

Berikutnya

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