Registration

Grand Valley State University seeks to bring together youth service providers, K-12 educators, higher education faculty and staff, and community leaders to understand and interrogate the “systems” that impact the lives of Black boys & men in order to deconstruct and rebuild for their success.

Through a lens of intersectionality, the Black Boys & Men National Symposium looks holistically at the lives of Black boys & men in a variety of educational and other contexts. The symposium is focused on creating a vision for equitable transformation throughout the educational pipeline, from K-12 to higher education and beyond. The symposium is designed to be a place of personal and professional growth for those who walk alongside Black boys & men to engage in discussion, learning, and action.

Attendee Registration Rate:

Pre-Registration Rate (Ends November 30th): $450

Early Bird Rate (December 1st - February 28th): $500

Regular Rate (March 1st - June 1st): $600

Late Registration Rate (June 2nd - June 10th): $700

Registration closes June 10th at 11:59pm

* denotes a required field

Attendee Information

What are you registering for? *

First Name (as you would like it to appear on your name badge) *

Last Name *

Pronouns *
Please specify a value for Pronouns

Organization

Title/Role (Non-Student)

Affiliation *

Email *

Cell Phone *

Work Phone

Country *

Address 1 *

Address 2

City *

State/Province *

Zip/Postal *

Dietary Restrictions (conference fees include meals) *
No Restrictions
Vegetarian
Vegan
Gluten Free
Not listed Please specify a value for Dietary Restrictions (conference fees include meals)

Any Accessibility Needs? *

Additional Attendee Information

How many additional attendees are you registering?

Attendee 1

What are you registering for? *

First Name (as you would like it to appear on your name badge) *

Last Name *

Pronouns *
Please specify a value for Pronouns

Organization

Title/Role (Non-Student)

Affiliation *

Email *

Cell Phone *

Work Phone

Country *

Address 1 *

Address 2

City *

State/Province *

Zip/Postal *

Dietary Restrictions (conference fees include meals) *
No Restrictions
Vegetarian
Vegan
Gluten Free
Not listed Please specify a value for Dietary Restrictions (conference fees include meals)

Any Accessibility Needs? *

Attendee 2

What are you registering for? *

First Name (as you would like it to appear on your name badge) *

Last Name *

Pronouns *
Please specify a value for Pronouns

Organization

Title/Role (Non-Student)

Affiliation *

Email *

Cell Phone *

Work Phone

Country *

Address 1 *

Address 2

City *

State/Province *

Zip/Postal *

Dietary Restrictions (conference fees include meals) *
No Restrictions
Vegetarian
Vegan
Gluten Free
Not listed Please specify a value for Dietary Restrictions (conference fees include meals)

Any Accessibility Needs? *

Attendee 3

What are you registering for? *

First Name (as you would like it to appear on your name badge) *

Last Name *

Pronouns *
Please specify a value for Pronouns

Organization

Title/Role (Non-Student)

Affiliation *

Email *

Cell Phone *

Work Phone

Country *

Address 1 *

Address 2

City *

State/Province *

Zip/Postal *

Dietary Restrictions (conference fees include meals) *
No Restrictions
Vegetarian
Vegan
Gluten Free
Not listed Please specify a value for Dietary Restrictions (conference fees include meals)

Any Accessibility Needs? *

Attendee 4

What are you registering for? *

First Name (as you would like it to appear on your name badge) *

Last Name *

Pronouns *
Please specify a value for Pronouns

Organization

Title/Role (Non-Student)

Affiliation *

Email *

Cell Phone *

Work Phone

Country *

Address 1 *

Address 2

City *

State/Province *

Zip/Postal *

Dietary Restrictions (conference fees include meals) *
No Restrictions
Vegetarian
Vegan
Gluten Free
Not listed Please specify a value for Dietary Restrictions (conference fees include meals)

Any Accessibility Needs? *

Attendee 5

What are you registering for? *

First Name (as you would like it to appear on your name badge) *

Last Name *

Pronouns *
Please specify a value for Pronouns

Organization

Title/Role (Non-Student)

Affiliation *

Email *

Cell Phone *

Work Phone

Country *

Address 1 *

Address 2

City *

State/Province *

Zip/Postal *

Dietary Restrictions (conference fees include meals) *
No Restrictions
Vegetarian
Vegan
Gluten Free
Not listed Please specify a value for Dietary Restrictions (conference fees include meals)

Any Accessibility Needs? *

Attendee 6

What are you registering for? *

First Name (as you would like it to appear on your name badge) *

Last Name *

Pronouns *
Please specify a value for Pronouns

Organization

Title/Role (Non-Student)

Affiliation *

Email *

Cell Phone *

Work Phone

Country *

Address 1 *

Address 2

City *

State/Province *

Zip/Postal *

Dietary Restrictions (conference fees include meals) *
No Restrictions
Vegetarian
Vegan
Gluten Free
Not listed Please specify a value for Dietary Restrictions (conference fees include meals)

Any Accessibility Needs? *

Attendee 7

What are you registering for? *

First Name (as you would like it to appear on your name badge) *

Last Name *

Pronouns *
Please specify a value for Pronouns

Organization

Title/Role (Non-Student)

Affiliation *

Email *

Cell Phone *

Work Phone

Country *

Address 1 *

Address 2

City *

State/Province *

Zip/Postal *

Dietary Restrictions (conference fees include meals) *
No Restrictions
Vegetarian
Vegan
Gluten Free
Not listed Please specify a value for Dietary Restrictions (conference fees include meals)

Any Accessibility Needs? *

Attendee 8

What are you registering for? *

First Name (as you would like it to appear on your name badge) *

Last Name *

Pronouns *
Please specify a value for Pronouns

Organization

Title/Role (Non-Student)

Affiliation *

Email *

Cell Phone *

Work Phone

Country *

Address 1 *

Address 2

City *

State/Province *

Zip/Postal *

Dietary Restrictions (conference fees include meals) *
No Restrictions
Vegetarian
Vegan
Gluten Free
Not listed Please specify a value for Dietary Restrictions (conference fees include meals)

Any Accessibility Needs? *

Attendee 9

What are you registering for? *

First Name (as you would like it to appear on your name badge) *

Last Name *

Pronouns *
Please specify a value for Pronouns

Organization

Title/Role (Non-Student)

Affiliation *

Email *

Cell Phone *

Work Phone

Country *

Address 1 *

Address 2

City *

State/Province *

Zip/Postal *

Dietary Restrictions (conference fees include meals) *
No Restrictions
Vegetarian
Vegan
Gluten Free
Not listed Please specify a value for Dietary Restrictions (conference fees include meals)

Any Accessibility Needs? *

Attendee 10

What are you registering for? *

First Name (as you would like it to appear on your name badge) *

Last Name *

Pronouns *
Please specify a value for Pronouns

Organization

Title/Role (Non-Student)

Affiliation *

Email *

Cell Phone *

Work Phone

Country *

Address 1 *

Address 2

City *

State/Province *

Zip/Postal *

Dietary Restrictions (conference fees include meals) *
No Restrictions
Vegetarian
Vegan
Gluten Free
Not listed Please specify a value for Dietary Restrictions (conference fees include meals)

Any Accessibility Needs? *

Attendee 11

What are you registering for? *

First Name (as you would like it to appear on your name badge) *

Last Name *

Pronouns *
Please specify a value for Pronouns

Organization

Title/Role (Non-Student)

Affiliation *

Email *

Cell Phone *

Work Phone

Country *

Address 1 *

Address 2

City *

State/Province *

Zip/Postal *

Dietary Restrictions (conference fees include meals) *
No Restrictions
Vegetarian
Vegan
Gluten Free
Not listed Please specify a value for Dietary Restrictions (conference fees include meals)

Any Accessibility Needs? *

Attendee 12

What are you registering for? *

First Name (as you would like it to appear on your name badge) *

Last Name *

Pronouns *
Please specify a value for Pronouns

Organization

Title/Role (Non-Student)

Affiliation *

Email *

Cell Phone *

Work Phone

Country *

Address 1 *

Address 2

City *

State/Province *

Zip/Postal *

Dietary Restrictions (conference fees include meals) *
No Restrictions
Vegetarian
Vegan
Gluten Free
Not listed Please specify a value for Dietary Restrictions (conference fees include meals)

Any Accessibility Needs? *

Attendee 13

What are you registering for? *

First Name (as you would like it to appear on your name badge) *

Last Name *

Pronouns *
Please specify a value for Pronouns

Organization

Title/Role (Non-Student)

Affiliation *

Email *

Cell Phone *

Work Phone

Country *

Address 1 *

Address 2

City *

State/Province *

Zip/Postal *

Dietary Restrictions (conference fees include meals) *
No Restrictions
Vegetarian
Vegan
Gluten Free
Not listed Please specify a value for Dietary Restrictions (conference fees include meals)

Any Accessibility Needs? *

Attendee 14

What are you registering for? *

First Name (as you would like it to appear on your name badge) *

Last Name *

Pronouns *
Please specify a value for Pronouns

Organization

Title/Role (Non-Student)

Affiliation *

Email *

Cell Phone *

Work Phone

Country *

Address 1 *

Address 2

City *

State/Province *

Zip/Postal *

Dietary Restrictions (conference fees include meals) *
No Restrictions
Vegetarian
Vegan
Gluten Free
Not listed Please specify a value for Dietary Restrictions (conference fees include meals)

Any Accessibility Needs? *

Attendee 15

What are you registering for? *

First Name (as you would like it to appear on your name badge) *

Last Name *

Pronouns *
Please specify a value for Pronouns

Organization

Title/Role (Non-Student)

Affiliation *

Email *

Cell Phone *

Work Phone

Country *

Address 1 *

Address 2

City *

State/Province *

Zip/Postal *

Dietary Restrictions (conference fees include meals) *
No Restrictions
Vegetarian
Vegan
Gluten Free
Not listed Please specify a value for Dietary Restrictions (conference fees include meals)

Any Accessibility Needs? *

Attendee 16

What are you registering for? *

First Name (as you would like it to appear on your name badge) *

Last Name *

Pronouns *
Please specify a value for Pronouns

Organization

Title/Role (Non-Student)

Affiliation *

Email *

Cell Phone *

Work Phone

Country *

Address 1 *

Address 2

City *

State/Province *

Zip/Postal *

Dietary Restrictions (conference fees include meals) *
No Restrictions
Vegetarian
Vegan
Gluten Free
Not listed Please specify a value for Dietary Restrictions (conference fees include meals)

Any Accessibility Needs? *

Attendee 17

What are you registering for? *

First Name (as you would like it to appear on your name badge) *

Last Name *

Pronouns *
Please specify a value for Pronouns

Organization

Title/Role (Non-Student)

Affiliation *

Email *

Cell Phone *

Work Phone

Country *

Address 1 *

Address 2

City *

State/Province *

Zip/Postal *

Dietary Restrictions (conference fees include meals) *
No Restrictions
Vegetarian
Vegan
Gluten Free
Not listed Please specify a value for Dietary Restrictions (conference fees include meals)

Any Accessibility Needs? *

Attendee 18

What are you registering for? *

First Name (as you would like it to appear on your name badge) *

Last Name *

Pronouns *
Please specify a value for Pronouns

Organization

Title/Role (Non-Student)

Affiliation *

Email *

Cell Phone *

Work Phone

Country *

Address 1 *

Address 2

City *

State/Province *

Zip/Postal *

Dietary Restrictions (conference fees include meals) *
No Restrictions
Vegetarian
Vegan
Gluten Free
Not listed Please specify a value for Dietary Restrictions (conference fees include meals)

Any Accessibility Needs? *

Attendee 19

What are you registering for? *

First Name (as you would like it to appear on your name badge) *

Last Name *

Pronouns *
Please specify a value for Pronouns

Organization

Title/Role (Non-Student)

Affiliation *

Email *

Cell Phone *

Work Phone

Country *

Address 1 *

Address 2

City *

State/Province *

Zip/Postal *

Dietary Restrictions (conference fees include meals) *
No Restrictions
Vegetarian
Vegan
Gluten Free
Not listed Please specify a value for Dietary Restrictions (conference fees include meals)

Any Accessibility Needs? *

Attendee 20

What are you registering for? *

First Name (as you would like it to appear on your name badge) *

Last Name *

Pronouns *
Please specify a value for Pronouns

Organization

Title/Role (Non-Student)

Affiliation *

Email *

Cell Phone *

Work Phone

Country *

Address 1 *

Address 2

City *

State/Province *

Zip/Postal *

Dietary Restrictions (conference fees include meals) *
No Restrictions
Vegetarian
Vegan
Gluten Free
Not listed Please specify a value for Dietary Restrictions (conference fees include meals)

Any Accessibility Needs? *

Attendee 21

What are you registering for? *

First Name (as you would like it to appear on your name badge) *

Last Name *

Pronouns *
Please specify a value for Pronouns

Organization

Title/Role (Non-Student)

Affiliation *

Email *

Cell Phone *

Work Phone

Country *

Address 1 *

Address 2

City *

State/Province *

Zip/Postal *

Dietary Restrictions (conference fees include meals) *
No Restrictions
Vegetarian
Vegan
Gluten Free
Not listed Please specify a value for Dietary Restrictions (conference fees include meals)

Any Accessibility Needs? *

Attendee 22

What are you registering for? *

First Name (as you would like it to appear on your name badge) *

Last Name *

Pronouns *
Please specify a value for Pronouns

Organization

Title/Role (Non-Student)

Affiliation *

Email *

Cell Phone *

Work Phone

Country *

Address 1 *

Address 2

City *

State/Province *

Zip/Postal *

Dietary Restrictions (conference fees include meals) *
No Restrictions
Vegetarian
Vegan
Gluten Free
Not listed Please specify a value for Dietary Restrictions (conference fees include meals)

Any Accessibility Needs? *

Attendee 23

What are you registering for? *

First Name (as you would like it to appear on your name badge) *

Last Name *

Pronouns *
Please specify a value for Pronouns

Organization

Title/Role (Non-Student)

Affiliation *

Email *

Cell Phone *

Work Phone

Country *

Address 1 *

Address 2

City *

State/Province *

Zip/Postal *

Dietary Restrictions (conference fees include meals) *
No Restrictions
Vegetarian
Vegan
Gluten Free
Not listed Please specify a value for Dietary Restrictions (conference fees include meals)

Any Accessibility Needs? *

Attendee 24

What are you registering for? *

First Name (as you would like it to appear on your name badge) *

Last Name *

Pronouns *
Please specify a value for Pronouns

Organization

Title/Role (Non-Student)

Affiliation *

Email *

Cell Phone *

Work Phone

Country *

Address 1 *

Address 2

City *

State/Province *

Zip/Postal *

Dietary Restrictions (conference fees include meals) *
No Restrictions
Vegetarian
Vegan
Gluten Free
Not listed Please specify a value for Dietary Restrictions (conference fees include meals)

Any Accessibility Needs? *

Attendee 25

What are you registering for? *

First Name (as you would like it to appear on your name badge) *

Last Name *

Pronouns *
Please specify a value for Pronouns

Organization

Title/Role (Non-Student)

Affiliation *

Email *

Cell Phone *

Work Phone

Country *

Address 1 *

Address 2

City *

State/Province *

Zip/Postal *

Dietary Restrictions (conference fees include meals) *
No Restrictions
Vegetarian
Vegan
Gluten Free
Not listed Please specify a value for Dietary Restrictions (conference fees include meals)

Any Accessibility Needs? *

After May 2, 2025 registration is non-refundable. If your payment is refundable, you may request it by contacting the GVSU office to which payment was made, or by calling (616) 331-2200. *
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Page last modified September 17, 2024

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