Black History Month Events Registration

We are excited you have chosen to join us for our 2022 Black History Month events! Please complete the registration form below and select the events you'll be attending. For questions, please email us at blacksuccess@santarosa.edu or call 707-524-1512.

Name*

First Name

Last Name

SRJC Student ID Number (If you are an SRJC employee, please enter 0000)*

Email*

Phone Number (Phone Number (You ma receive text reminders and notifications)*

Do you need disability related accomodations?*

Yes No

Which events are you attending? *

Black Yoga Series / Lindsey Cacy on Monday, January 31st, February 7th, 14th, 21st & 28th / 5:30 - 6:30 Roses Growing From Concrete / Dr. Ed Bush on Wednesday, February 9th / 11:00 - 1:00 Black Love Paint Night / DJ Bjay Licht on Sunday, February 13th / 6:00 - 8:00 Queering Black History: The Power of Storytelling on Wednesday, February 16th / 11:00 - 12:00 Texturas Marrón: Políticas Raciales en / Bocafloja on Wednesday, February 23rd / 4:30 - 5:30 Black Down Memory Lane / Dr. Ameer Hasan Loggins on Monday, February 28th from 10:30 - 12:00

Addres (If you selected Black Yoga Series or Black Love Paint Night, please enter your address for supplies to mailed)

Address Line 1

Address Line 2

City

State

ZIP Code