Form

Crash Dialogues are held on Tuesdays or Thursdays from 9 a.m. to 1 p.m. but the location varies depending on the date. Click on the drop-down below to select the date and location of the Crash session you wish to attend.

Crash Dialogue Date*

First Name*

Last Name*

Company/School

E-mail*

Work Phone

Home/cell Phone*

Address*

City*

State*

Credit Card payment through PayPal*

1 Attendee $30.00 USD
2 Attendees $60.00 USD
1 Student $20.00 USD
2 students $40.00 USD

Total: $0.00 USD

To pay for Crash Dialogues by check, print this form, complete it and mail the form and payment to Diversity Focus, 222 2nd Street SE, Cedar Rapids, IA 52401

Please enter the security word shown on the right*