Name *

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

Are you 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

How would you prefer to submit payment? *

Please send an invoice

I'd prefer to pay online

I will mail a check to nINA Collective (address can be found at the bottom of this webpage). Please write "Facilitator Cohort" on the memo of your check.