Diversity & Inclusion Summit CZ

ATTENDEE REGISTRATION FORM

June 21-24, 2018
Cleveland State University
Cleveland, OH

Hosted by Ohio Swimming and the Mason Manta Rays

SUMMIT ATTENDEE MUST BE A USASWIMMING MEMBER

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First name *

Last Name *

Address *

City *

State *

Zip Code *

Email Address *

Cell Phone (include area code) *

Gender *

LSC *

LSC Role *

General Chair

Diversity Chair

Volunteer

Official

Other Other

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Please select the topics that you are interested in (you can pick more than one) *

USA Swimming Resources D&I

Multicultural Marketing

Fundraising

Socioeconomic Disparities

Safe Sport

Best practices in LSCs

LGBT Resources

What to say and what not to say

Other Topics Other Topics

Please list the zone and / or LSC Diversity & Inclusion events that you have attended (Zone/LSC Diversity Camp, Coaches Clinic, Catch a Spirit Camp, Sigma Gamma Rho event, etc.)

	Event Name	Date	ROLE (Coach, Volunteer, Official, Presenter, etc.)
Event 1	Event Name	Date	ROLE (Coach, Volunteer, Official, Presenter, etc.)
Event 2	Event Name	Date	ROLE (Coach, Volunteer, Official, Presenter, etc.)
Event 3	Event Name	Date	ROLE (Coach, Volunteer, Official, Presenter, etc.)

Please indicate the reason(s) that you plan on attending the USA Swimming Diversity & Inclusion Regional Summit. *

Please indicate what you expect to derive from the experience. *

Please indicate what you expect to contribute to the experience. *

Would you like to subscribe to USA Swimming’s Diversity & Inclusion Newsletter? *

Yes

No

I understand that as a USA Swimming Diversity & Inclusion Regional Summit Attendee I must abide by USA Swimming’s Code of Conduct. I attest that the above information is true and accurate. *

clear

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GO TO USASWIMMING.ORG/DIVERSITY OR TO YOUR ZONE SITE FOR

REGIONAL SUMMIT SCHEDULE INFORMATION!

USA Swimming is committed to a culture of inclusion and opportunity for people of diverse backgrounds, including, but not limited to, race, age, income, ethnicity, religion, gender, gender expression and sexual orientation.

Click the SUBMIT button when you have completed the form