Accelerated Policy Institute- Invoice Payment

If another party will be sponsoring your Institute participation, fill out this form and an invoice will be sent to the email address you specify. Also, please consider sponsoring a full or partial enrollment to support other women who cannot cover the cost to participate. To make this donation, click on the item below to add it to your cart.

Accelerated Policy Institute Donation

from $25.00

Name

First Name

Last Name

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Your Email Address

Phone Number

Organization, Community Group, or Employer

If none of these pertain to you, simply write "Self"

Your role with organization

e.g.: volunteer, board member, assistant director, etc. If you are not affiliated with an organization, simply write "Self".

Sponsoring Organization Information

Organization to Invoice

Contact at Organization

Organization Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Organization Phone Number

Organization Email Address to Invoice

Other Information

How would you describe yourself?

Completing this information is optional

Race/ethnicity:

Sexual orientation:

Gender identity

Preferred pronouns

Physical or other disability

Age

Additional Information

How would you primarily identify yourself?

If you answered other above, please specify

Identify issues areas in which you have deep content knowledge

Check all that apply

Women's health

Women's economic security

Women's safety

Other

If you answered other above, please specify issue area

Do you have any accessibility needs

Interpretation, large font, allergies, etc

How did you hear about the Policy Institute?

If you answered other above, please specify how you heard about us

Meal preferences

Gluten free

Dairy free

Vegetarian

Vegan

Other

If you answered other above, please specify meal preference