2005 Community Congress on Race Relations
Online Registration

( NOTE: Red asterisk "*" items are required )
Your Information:
Organization:
First Name:*
Last Name:*
Street Address:*
City, State Zip:* ,
Work Phone:
Home Phone:
Email:
Please Provide Answers to the Following (Optional):
Age:
Race:
Meal Preference:
Yes, I require accommodation for disability (please explain below):
Outreach Effectiveness:
In an effort to track the effectiveness of our outreach, please select one below if you are attending as a representative of a particular community:*
Business
GLBT
Government
Non-Profit
Media
Religion/Faith
Youth
Non-Specific
Please Select the Event(s) You Would Like to Attend:
I am interested in attending the Community Congress on Race Relations and keynote address.
I am only interested in attending the CCRR Resource Fair as a vendor (cost $50.00).