register 1 — povertythoughtforce

Register for the World Café on Education & Life Skills

Feb. 23, 6 - 7:30 p.m.
Biotech Place at Wake Forest Innovation Quarter
575 N. Patterson Ave. Winston-Salem

This session is filled. Please fill out this form if you would like to be placed on the wait list.

Please fill out all fields.

Name

First Name

Last Name

Email Address

Telephone

Street Address

City

State

ZIP Code

I am representing:

Myself

An organization

If you are representing an organization, what is the name of your organization?

If you are participating as an individual, please type N/A

Which role or sector will be your primary identification at this meeting?

This will assist us in knowing the composition of our attendees.

Non-profit

Government

Business/private sector

Faith-based

Community member