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Leiden, Together against racism!

Register

Vragen met een * moet u verplicht beantwoorden.

By completing this form you register for the City Talk ‘Leiden, Together against racism!’ This will take place on Thursday March 21 in 'Het Gebouw' in Leiden. You are welcome from 7:00 PM onwards.

The data collected in this form will only be used for the purpose of this meeting, in accordance with privacy regulations.

First name

Last name

Please fill in your last name.

Email address

Please fill in a valid email address.

Do you need anything?

We would like to hear which support/facilities you would like to use (other wishes can also be specified here). The location is wheelchair accessible.

Will you bring others who won’t/are unable to register themselves? If you are, how many others?

Please make your choice.

Would you like to stay informed about what happens next?

We will keep you informed by email.

YesNoPlease make your choice.

Do you want to become a member of a panel that advises the municipality on combating racism?

Yes, I want to join the youth panel (15 to 30 years old)Yes, I want to join the advisory group (18+)NoPlease make your choice.

Have you completed all required fields, but are unable to continue using the button Send ?
Press the enter or tab key.

Questions marked with ✱ are required.

Nog niet alle (verplichte) vragen beantwoord in: Register

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