Contact Name *

First Name

Last Name

Is this the person to whom we should send the invoice? *

Yes

No

If not, please include their name and email below

First Name

Last Name

Has your organization partnered with nINA Collective in the past? *

Yes

No

I'm not sure

Which of the following opportunities interest your organization *

(check all that apply)

Monthly Racial Equity Content

Reading & Reflection Group

Quarterly Leader Coaching Circle

Monthly Group Coaching

Member Spotlights & Virtual Conversations

Learning Communities and/or Co-Learning Opportunities

Facilitator Training

Annual Convening

Select Organizational Membership Package *

Community of Practice membership for up to 5 participants ($2500)

I'd like to add a Coaching Package of 6 one-one-one sessions for an additional $1200 to the Community of Practice Membership

Participant One

First Name

Last Name

Participant Two

First Name

Last Name

Participant Three

First Name

Last Name

Participant Four

First Name

Last Name

Participant Five

First Name

Last Name