Leadership & Racism Institute Registration

The registration fee for Just Organizations: Leadership & Racism Institute 2023 is:

$1,675 for EARLY REGISTRATION received by March 24, 2023, or
$1,875 for registration received by the FINAL REGISTRATION DEADLINE of May 19, 2023.

Room accommodations are based on shared occupancy. Single rooms are available for an additional total cost of $195 for the three nights.

Name(Required)

First Last

School District / Organization

Title / Position

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Email(Required)

Dietary Needs

T-Shirt Size(Required)

Identity

Due to the nature of this retreat, the following information is required:

Sex(Required)

Female

Male

Racial Identity(Required)

Mini Essays

How do you see yourself as a leader?(Required)

How does your leadership challenge racism?(Required)

Emergency Contact Information

Emergency Contact Name(Required)

First Last

Emergency Contact Phone(Required)

Relationship to Emergency Contact(Required)

Single Room Request

A limited number of single rooms will be available that require advanced payment. The additional fee of $195 for the three nights needs to be received on or before May 19, 2023. The single room fee is fully refundable.

Payer for LRI 2023

Will you pay for the Just Organizations: Leadership & Racism Institute 2023 now, or should we invoice your district / organization instead?

Yes, I will pay for the LRI 2023 at this time. Please add it to my total below.

No, please invoice my District/Organization and they will pay for the LRI 2023.

I prefer a single room for an additional cost of $195 for the three nights.(Required)

Yes, I want a single room

No, I do NOT want a single room

Payer for Single Room(Required)

Will you pay for the single room now, or should we invoice your district / organization to pay for the room?

Yes, I will pay for the single room at this time. Add it to my total now.

No, please invoice my District/Organization and they will pay for the single room.

Cancellation / Refund Policy
For cancelled registrations received on or before May 19, 2023, an amount of 50% will be refunded. For cancelled registrations received after May 19, 2023, there will be no refund.

Payment Information

2023 LRI Registration (early)

Price:

Single Room

Price:

Total

Credit Card

Cardholder Name

Card Details

Just Organizations: Leadership & Racism Institute 2023 - Registration Form

Identity

Mini Essays

Emergency Contact Information

Single Room Request

Payment Information