99Rise Workshop Registration
Thank you for your interest in the 99Rise training.  Please fill out this form, and we will contact you with details on the workshop, including location and what you will need to bring with you.  

We look forward to seeing you there.
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Contact Information
First Name *
Middle Name/Initial
Optional
Last Name *
Email Address *
If you do not have an email address, please let us know the best way to contact you.
Phone Number
Please DO NOT include dashes, symbols or spaces.
Street Address
City
State
Zip Code
Additional Questions
In our commitment to diversity and radical inclusion, we will prioritize the participation of women, people of color, LGBT communities, youth and elders, and other marginalized identities.  All of this information will be strictly confidential and will not be shared with anyone.
What is your age? *
Please let us know if you self-identify as any of these categories. *
Check all that apply.  Again, this information is optional and confidential.
Required
What is your gender? *
Why are you interested in this training?  What do you hope to gain?
What is your past experience with nonviolence?
Do you have any disabilities, allergies or any other considerations that we should be aware of?
Lunch
There is half an hour set aside for lunch, so there will not be much time for everyone to leave to get food.  We will be passing a hat around for pizza before lunch and one person will go and get it, are you interested in participating?
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