Taking It Up Registration Form

Workshop Dates (required)

District/Organization (required)

Address (required)

City, State, ZIP (required)

Team Member 1: Name and Title

Team Member 1: Racial Identity

Team Member 1: Phone

Team Member 1: Email

Team Member 2: Name and Title

Team Member 2: Racial Identity

Team Member 2: Phone

Team Member 2: Email

Team Member 3: Name and Title

Team Member 3: Racial Identity

Team Member 31: Phone

Team Member 3: Email

Team Member 4: Name and Title

Team Member 4: Racial Identity

Team Member 4: Phone

Team Member 4: Email

Method of Payment (required): $350/person

I have a PO number.I will mail a check.

Please mail checks made out to "OR Center for Educational Equity" to 5606 N. Maryland Ave., Portland, OR 97217 or enter your PO number below.