For each attendee, please provide the following information: Preferred Pronouns Title First Name* Last Name* Suffix Email Address* Organizational Position Organizational Unit/Department Organization Are you participating alone or as part of a team?* Individual Team If you are part of a team, please list your fellow team members, if known: Address* Address2 City* County* State/Province* Zip/Postal Code* Country* Phone Number* Demographic Information Please check any applicable boxes: (This information is for internal purposes and no personally identifying information will ever be shared with any third party.) Race/Ethnicity White/Caucasian Black/African-American Asian-American/Pacific Islander Native American/First Peoples ispanic/Latino Multiracial/Multiple Heritage I prefer not to answer Sex/Gender Orientation and Identity Female Male Intersex Agender - as a sex/gender identity Other Sex/Gender Identity Heterosexual/Straight Homosexual/Gay/Lesbian Bisexual/Pansexual Asexual - as a sex/gender orientation Transsexual/Transgender Genderqueer/Gender-fluid Other Sex/Gender Orientation If you have a disability which may require accommodation, please provide any details you feel are necessary, so that we can do our best to ensure your comfort: Special Dietary Considerations History Have you participated in the Vermont Vision for a Multicultural Future Conference in prior years?* New Participant 2018 2017 2016 2015 2014 2013 2012 Have you previously facilitated a workshop at the Vermont Vision for a Multicultural Future Conference? Please list workshop topics you have facilitated: Notes Please include any additional information or details you feel are relevant to your registration: