Combat Hate School Registration Form

Combat Hate Registration

Requested Workshop Dates(Required)

Please list the dates you are interested having this workshop. If you are unsure, please write UNKNOWN.

Name(Required)

First Last

Title

Phone(Required)

Email(Required)

School/Organization Name(Required)

Address(Required)

Street Address City ZIP Code

Grade Level(s)(Required)

Please provide what grade levels (7-12) will be participating in the workshops.

Student Total(Required)

Please provide an approximate number of students that will receive the workshop across the school. If you are unsure, please write UNKNOWN

Class Schedule (optional)

Please provide a copy of your school’s daily class schedule. If your schedule changes throughout the week, please provide adjusted schedule as well.

Drop files here or

Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 100 MB, Max. files: 5.

Additional Information or Requests

(Special Needs? Etc)

Phone

This field is for validation purposes and should be left unchanged.