REI individual registration

ATTENDEE'S MAILING ADDRESS *

ATTENDEE'S PHONE NUMBER *

AREA CODE PHONE NUMBER
DIETARY RESTRICTIONS

Gluten free Vegetarian Vegan Nut allergy
ATTENDEE'S RACE (FOR REI RECORDS) *

African American or black American Indian or Alaska native Asian Caucasian or white Hispanic or Latino(a) Native Hawaiian or other Pacific Islander
ATTENDEE'S AGE (FOR REI RECORDS) *

15-20 21-30 31-40 41-50 51-60 61-70 71-80 81-90 91-100
ATTENDEE'S GENDER (FOR REI RECORDS) *

Female Male Other
ATTENDEE'S INDUSTRY (FOR REI RECORDS) *

Business or corporation Education Faith-based organization Government Nonprofit Neighborhood resident Social justice organizer or advocate Retired
ATTENDEE'S SPONSORING ORGANIZATION (SEE NOTE AT TOP OF PAGE)

Ashley Hall Charleston County School District Charleston Kids Coalition Charleston Promise Neighborhood Coastal Community Foundation Grace City Church Meeting Street Schools Metanoia North Charleston Police Department Reading Partners (staff & board) Serenity Now Sophia Institute Teach for America Tri-County Cradle to Career Trident United Way Repeating REI participant
COMMENTS (IF ANY)
ATTENDEE'S DESIRED WORKSHOP *
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Feb 2019 Phase II
April 2019 Phase I
May 2019 Phase I
June 2019 Phase I
July 2019 Phase I
August 2019 Phase I
Sept 2019 Phase I
Oct 2019 Phase I
Nov 2019 Phase I
ARE YOU A YWCA.GC MEMBER?
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10% OFF
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TOTAL COST

TOTAL COST

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