Examining Unconscious Bias Registration Form

Important Information

Please note: Attendance is required at all sessions, as each session builds upon the previous. Please ensure you are able to attend all of the virtual program sessions before you apply.

DATES: November 10, 12, 17, 19 from 9:30 a.m. - 12:30 p.m.

Registration Type

Quantity:

*Note: If you are purchasing a group of 10 or multiple (2-9) individual registrations at once, we will be in touch to collect your participant names and details. They will be due by October 30.

First Name

Last Name:

Title (i.e. Director of Marketing):

E-mail:

Company Name:

Business Address:

Business City:

Business State

Business ZIP Code

Business Phone:

Home ZIP Code:

Cell Phone:

What is your preferred pronoun?

I identify my ethnicity as:

AsianBlack/African AmericanCaucasianHispanic/LatinxNative AmericanPacific IslanderMiddle EasternPrefer not to shareOther

INvoice Contact - Who shall we send the invoice to for THE program registration fee?

First Name

Last Name

Title:

Email:

Have you ever attended an ICAN program?:

Please list ICAN programs or events you've attended:

Any Additional Information:

If you DO NOT wish for your pictures or comments to be used in ICAN promotional materials please check the box.

I UNDERSTAND THAT ALL INFORMATION SUBMITTED WILL BE USED BY THE ICAN, INC. OFFICE AND FACULTY ONLY. FACILITATORS PLEDGE ABSOLUTE CONFIDENTIALITY REGARDING INFORMATION CONTAINED IN ALL PROGRAM ENGAGEMENTS.

I UNDERSTAND THAT SUBMISSION OF THIS COMPLETED REGISTRATION INDICATES THAT BOTH MY EMPLOYER AND I HAVE REVIEWED AND ACCEPT THE PROGRAM'S REQUIRED COMMITMENT OF TIME AND FINANCIAL RESOURCES. TUITION IS NONREFUNDABLE. SUBMISSION OF A COMPLETED REGISTRATION INDICATES YOU ACCEPT THESE REFUND TERMS.

I accept these terms

Please note: Once your registration is received, you will receive an email confirmation from ICAN. IF YOU DO NOT RECEIVE AN EMAIL WITHIN THE NEXT BUSINESS WEEK, please contact ICAN at ican@icanglobal.net to confirm receipt of your registration.

Contact Information