Decoding Race Online Registration – Anima Leadership eLearning

Your Information

First Name *

Last Name *

Pronouns

For example: she/her, he/him, they/them, etc

Position:

Organization:

Email *

Phone

I consent to Anima Leadership using my email address for all future communications.

Yes

No

If you are already taking online courses with us, please use the same username and password.

Username *

Your Username has to be all lower case letters, with no spaces or special characters. We recommend using your first and last name, run together as one word. Or, you can make up something unique. Minimum length is 5 characters, and maximum is 20.

Password *

A password is required to access the course materials. If you have already registered for a previous Anima Online course, you can either use the same password, or enter a new one to reset your password for all courses.

Confirm Password *

Please reenter your password to confirm.

Registering for another person

I am registering for another person

My Name *

My Email *

My Phone *

The Course

Course Title

Group Selection

Winter Group (November 29th and December 1st, 2022, 1-4pm EST)

Fall Group (October 18th and 25th, 2023, 1-4pm EST)

Your Attendee Profile

Do you identify as a member of an equity seeking group?

Yes

No

Prefer not to Answer

If Yes:

Are you in a management role?

Yes

No

No, but I hope to be

Anima will be recording each webinar and chat for internal use by you and other participants for learning purposes (e.g. missed sessions, review of concepts). This will include the plenary sessions but the small group breakouts will NOT be recorded. I understand and consent to the course sessions being recorded and shared with other participants. *

Yes

Participation and Expectations

Do you require any accommodations or have any accessibility issues?

Yes

No

Please describe any required accommodations that would support your learning experience?

Please tell us a bit about yourself and your expectations for the course:

Payment Method

I currently reside: *

Outside of Canada (international)

In Canada

Course Price *

Payment by *

Credit Card

Payment as previously arranged

Payment is typically by credit card. If you have made other arrangements, such as payment by invoice, select ‘Payment as previously arranged’ here.

Payment Arrangements

Thank you – Please continue with your registration, clicking the Submit button at the bottom of the form when you are done. You will bypass the online payment screen. If you have any questions about your payment arrangements, contact info@animaleadership.com

Coupon

Coupon Code

I have a Coupon Code issued by Anima Leadership

Enter your Coupon Code, here:

If you have been given a coupon code, enter it here. If you have questions about the code, contact info@animaleadership.com

Billing Information (obsolete)

Pre-Tax Price

HST

Total Price

Coupon Payment

Agreed Price

Input numerical value only (please do not add $ or USD).

Payment

Name on Card

First

Last Name on Card

Last

Credit Card

Month

BillingAddress

City

State/Province

Zip/Postal

Country