Black-White Dialogues - REGISTRATION FORM

Return to Main Menu

Thanks for registering for the third series of Black-White Dialogues. We look forward to getting to know you on six (6) Tuesdays: September 7, 14, 21, 28 and October 5, and 12, 2010 from 7:00 p.m. until 9:00 p.m.
All of the Dialogue meetings will be at:
First Central Congregational Church
421 S. 36th Street
Omaha, NE      68131
You may call Elaine Wells at 573-1702 or cell phone 415-9500 if you have questions or concerns.

If you are part of a couple who both plan to attend, please register seperately.

    (Mr., Mrs., Ms. Miss, etc.)
    Example:  402-555-1234
    Example:  402-555-1234
    Example:  402-555-1234
    Example:  402-555-1234



We plan to have 30 Black and 30 White individuals for the one-to-one Dialogues. Check your race:
Black White



Are you willing to follow these guidelines?
  1. I will arrive on time and ready to participate. If I must be late, I'll come in quietly and not disturb the proceedings.
  2. If I can't attend a meeting, I'll call Elaine Wells in advance so that someone can fill in for me that evening.
  3. I will listen respectfully, and share my experiences honestly and diplomatically.
  4. I will use the recommended communication skills to the best of my ability : (see Communication Skills for Dialogues tab on home page).
  5. I will not lecture, talk longer than the allotted time, nor share confidential information.
Yes No
Yes No

(Maximum characters: 255)
You have characters left.



(Maximum characters: 1000)
You have characters left.