PRI COVID-19 Community Convening Orientation

Your Registration Info

First Name *

Last Name *

Email Address *

Organization / Affiliation *

Title / Role *

Home Postal Code *

Phone *

Share up to two (2) neighborhoods you worked in during the pandemic. *

Please select your age group: *

Sector *

Choose only one sector please.

Select areas of support that your organization provided during the pandemic *

(Please select no more than two.)

Which Organization Referred You? *

Are you Requesting a Stipend for Community Expertise? *

Yes, I am an unpaid volunteer or a representative of an organization with an operating budget under $5 million AND my participation in this convening is not considered a part of my regular job responsibilities nor am I compensated by my employer for this work.

No, I am not requesting a stipend for my participation.

Race/Ethnicity *

Gender *

Female Male Transgender Other

Next year, we are hoping to have follow up discussions. Would you like to be contacted to participate in these? *

Yes

Choose Your Convening

Community Convening Dates

Choose One

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PRI COVID-19 Community Convening Orientation