Personal Information - 2026 Indiana Educational Equity Coalition Conference

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Summary
Agenda
Speakers

PERSONAL INFORMATION

Fill out the information below, then click next to continue.

* Registration Type

* First name

* Last name

* Email address

* Cell Phone

Demographics

* Ethnicity This question is required.

American Indian/Alaska Native
Asian
Black
Hispanic
Middle Eastern or North African
Multiracial
Native Hawaiian/Pacific Islander
Other Race or Ethnicity
Unknown
White

*

Gender

This question is required.

Male
Female
Transgender Male
Transgender Female
Gender Expansive/Non-conforming
Other

Pronouns (will be included on your name tag)

Emergency Contact

* Emergency Contact Name

* Emergency Contact Phone

* Emergency Contact Relationship (ex. Spouse)

Dietary Restrictions

Indicate any dietary restrictions. We strive to work with our food and beverage vendors to provide safe and delicious meals for those with dietary restrictions. Despite taking every precaution, we cannot guarantee that menu items are free of trace amounts of allergens or other ingredients.

Vegetarian (VEG)
Vegan (V)
Gluten-free (GF)
Non-dairy
Peanut or Tree Nut Allergy
Other

Register By

October 16, 2026

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