Skip to main content
User login
Username
*
Password
*
Request new password
You are here
CiviCRM
“Best Practices in DEI” Series -- Module 3: "Identifying & Mitigating UNCONSCIOUS BIAS" July 19 Online Workshop
How many people are you registering?
*
1
2
3
4
5
6
7
8
9
10
(including yourself)
Fill in your registration information on this page. If you are registering additional people, you will be able to enter their registration information after you complete this page and click "Continue".
Your Registration Info
First Name
*
Last Name
*
Email
*
Postal Code
*
Phone Number (Primary/Preferred)
Current Employer
Job Title
Primary Business Sector
- none -
Manufacturing
Service
Small Business
NonProfit
Government
Education-K12
Healthcare
Consultant
Individual (Non-Consultant)
Education-Higher Ed
How did you hear about it? (Check all that apply.)
Email
Flyer
Staff
Referral
Partner
LinkedIn
Facebook
Twitter
If PEN Partner is checked, which organization?
If Referral is checked, name of person?
Event Fee(s)
*
PEN Member -- this workshop only
-
$ 200.00
PEN Member Group (3-4 registering together) -- this workshop only
-
$ 175.00
PEN Member Group (5+ registering together) -- this workshop only
-
$ 150.00
Non-Member -- this workshop only
-
$ 400.00
PEN Premium Member -- this workshop only
-
$ 0.00
PEN Member -- Full DEI Series (5 remaining workshops, prorated)
-
$ 700.00
PEN Premium Member -- Full DEI Series (5 remaining workshops)
-
$ 0.00
Total Fee(s) for this participant
Payment Options
Payment Method
Pay by Credit Card
I prefer to be invoiced and pay by check.
Credit Card
If you have a PayPal account, you can click the PayPal button to continue. Otherwise, fill in the credit card and billing information on this form and click
Continue
at the bottom of the page.
Checkout securely. Pay without sharing your financial information.
Card Type
- select -
Visa
MasterCard
Amex
Discover
Card Number
*
Security Code
*
Expiration Date
*
-month-
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
-year-
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
My billing address is the same as above
Billing Name and Address
Billing First Name
*
Billing Middle Name
Billing Last Name
*
Street Address
*
City
*
Country
*
- select -
United States
State/Province
*
- none -
Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
United States Minor Outlying Islands
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Postal Code
*