PENINSULA DIVERSITY DIALOGUE DAY 2022 SCHOOL REGISTRATION FORM

*This form must be received by VCIC by October 7*
Please write out the full name of the school
Please include area code
To reach you on the day of the program (include your area code)

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

In order to ensure full registration and to help us create breakout groups that are as diverse as possible, all student names and completed permission forms are required prior to the program. If unable to fill in now, contact Paula L. Bazemore prior to October 7 ([email protected]). If you don't plan to fill all 12 spots, type N/A.

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