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On-Line Registration for Working Group on Organizing and the Academy The "submit" button is at the bottom of this page. The form will be sent to Rob Kleidman at r.kleidman@csu-e.csuohio.edu You should receive an automatic receipt via e-mail shortly |
| Name: | |
| Organization: | |
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| Title or position: | |
| Phone: | |
| Fax: | |
| E-mail: | |
| Please describe why you are interested in participating in the workshop: | |
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| There is some funding available to support the travel expenses of community organizers and community organization leaders. Please complete the following questions if you would like to be considered for travel funds. | |
| Organization Name: | |
| Organization Address: | |
| Organization E-mail (if available): | |
| Annual Budget: | |
| Number of Staff: | |
| Sex: | Female
Male |
| Race (please use the text box if you wish to self-identify): | Black/African American
Asian or Pacific Islander American Indian or Alaskan Native Hispanic (persons of Spanish culture or origin, regardless of race) White |
Click on "Return" to go back to the working group homepage. And Thank you!