Name: Racial Equity Institute
Start: 2023-01-12
End: 2023-01-13

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Demographics

The following are optional questions to help YWCA Lancaster better understand the community we're engaging with!

What is your age?

What is your race?

American Indian/Alaskan Native (ie. Aboriginal Australian, First Nations, Native American)
Asian (Central Asian, East Asian, South Asian, Southeast Asian)
Black/African American (having origins in Sub-Saharan Africa)
Middle Eastern/North African (including the Middle East, North Africa and the Arab World)
Native Hawaiian or Other Pacific Islander (a person having origins in any of the original people of Hawaii, Guam, Samoa, or other Pacific Islands)
White/European descent
Prefer not to answer

What is your ethnicity?

Hispanic or Latino (A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.)
Not Hispanic or Latino
Prefer not to answer

What is your gender?

Suggested donation:

Racial Equity Institutes are provided without charge, but we appreciate your support of our programming! Suggested donation: $15-25

Credit Card

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Attendees

If different than above, please let us know the names of the people attending

Additional Information

Let us know of any other information about this registration.

Racial Equity Institute