PREJUDICE AWARENESS SUMMIT 2020 SCHOOL REGISTRATION FORM

*This form must be received by VCIC by October 9, 2020*
Please write out the full name of the school
Select your school district from the drop down menu (click to see additional options)
Please include area code
To reach you on the day of the program (include your area code)
(note that this opportunity is available on a first-come, first-served basis)
(note that this opportunity is available on a first-come, first-served basis)

PLEASE SHARE THE FULL NAMES OF THE STUDENTS YOU WOULD LIKE TO REGISTER:

All student names and completed permission forms are required prior to the program. If unable to fill in now, contact Paula Bazemore prior to October 2 (pbazemore@inclusiveVA.org). If you don't plan to fill all 5 spots, type N/A.

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