Blandin Foundation Leadership Programs does not and shall not discriminate on the basis of race, color, religion (creed), gender, gender expression, age, national origin (ancestry), disability, marital status, sexual orientation, or military status, in any of its activities or operations. These activities include, but are not limited to, selection of volunteers including program participants and vendors, and provision of services. We are committed to providing an inclusive and welcoming environment for all members of our staff, participants, volunteers, independent contractors, and vendors.

Tell Us About You

Leaders Partnering to End Poverty (LPEP) Registration Form

First Name

Preferred First Name

The first name you would like to appear on your name tags

Last Name

Home Mailing Address

Home City

Home State

2 character limit

Home Zip/Postal Code

Personal Email

Work Email

Preferred Email

Home Phone

Work Phone

Mobile Phone

Preferred Phone

Gender

Race/Ethnicity (select all that apply)

African American/Black

American Indian/Native American

Asian

Caucasian

Hispanic/Latino

Pacific Islander

Other Race/Ethnicity

The Blandin Foundation reserves the right to rescind any invitation to participate in any of its programs up to, and during, the program.

Questions? Contact Tom Sippola at tjsippola@blandinfoundation.org or at 877-882-2257 Ex 737.

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