Contact *

First Name

Last Name

Are you registering as an individual or an organization? *

This registration is for me

This registration is for a group or organization

Is your organization a member of the nINA Collective Community of Practice? *

Yes

No

I'm not sure

Has your organization ever partnered with the nINA Collective? *

Yes, we partnered with nINA in the past

Yes, we are a current partner

No

I'm not sure

What are you (or your organization) interested in facilitating?

Select any that apply

Lunch and Learns

Book studies

Racial Affinity Caucuses

Committee and/or Team meetings

Informal discussions

Other

Participant One

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Last Name

Participant Two

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Last Name

Participant Three

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Participant Four

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Participant Five

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Last Name