Event Registration Form

How do you describe your gender identity?

With what racial and ethnic group do you identify?

How do you describe your disability/ability status?

Other disability or impairment

Have you ever served in the military?

Yes

Decline to answer

What branch of the military did you serve in?

Era of service

Is the disability you listed above related to your military service?

Yes

Decline to answer

Has an immediate member of your family served in the military?

Yes

Decline to answer

What branch of the military did they serve in?

What was their era of service?

For Organization Information below, enter the information specific to your membership/affiliation location, even if the organization has multiple locations.

What is your primary membership/affiliation?

Enter your full campus name:

Organization City

Organization State

Organization Postal Code

Organization Country

Start Date (1)

Shift Id