Practice Form

Name*

First Last

Email*

Address

Street Address Address Line 2 City State ZIP Code

Organization*

Your Title*

Is your organization BIPOC-led?*

Yes
No

BIPOC-led is defined as CEO/ED/President is Black, Indigenous or Person of Color or at least 50% of the board identifies as Black, Indigenous or Person of Color.

Organizational Service Area (select all that apply)*

If you selected "other" above, please enter the county/counties you serve here:

Do you have any dietary restrictions?

Vegetarian
Dairy-free
Gluten-free
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Other

If you entered "other" in the above dietary question, please list your dietary needs/restriction(s) here:

Number of Registrants *

Price: $1.00

Names of Attendees*

Full Name	Title	Email

Please list everyone attending, including yourself. Use the plus sign to the right to add more attendees.

Optional Demographic Information

Nonprofit Academy offers high-quality, low-cost trainings to nonprofits in Central Minnesota thanks, in part, to generous grant support. As such we also complete grant reports for funders. Please provide the following demographic information to assist in our grant reporting. This section is optional. This information is confidential and will only be reported in aggregate.

Year of Birth

Race/Ethnic Background

Are you Hispanic/Latino? (of any race)

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No

Are you a member of the LGBTQIA+ community?

Yes
No

Citizenship

Gender

Female
Male
Non-binary

Veteran Status

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Payment Information

Card Billing Address

Street Address Address Line 2 City State ZIP Code

Total

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Optional Demographic Information

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Little Falls Office

St. Cloud Office

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