2021 State of Black South Florida RSVP

Presented by the South Florida Black Prosperity Alliance (SFBPA)

Thank you for your interest in attending the 2021 State of Black South Florida. The SFBPA is excited to welcome you to this important collaboration forum, as we focus on the critical priority areas that impact the historical, current and long-term outcomes for our Black communities across the Tri-County.

Date: Saturday, September 25, 2021

Time: 8:00am-12:00pm

Location: Florida International University, Biscayne Bay Campus, Wolfe University Center | 3000 NE 151st St, North Miami Beach, FL 33181

Parking: Lot 1 and Lot 2 (unmarked gray spaces)

Prefix/Preferred Title
First Name
Last Name
Email
Phone
Company/Organization/Business
Are you a current member of the SFBPA?

Are you a current member of the SFBPA? Yes No
Are you currently serving on a SFBPA working committee? Select all that apply

Are you currently serving on a SFBPA working committee? Select all that apply Education Youth Development Government Affairs & Advocacy Outreach & Membership PR/Marketing & Communications Healthcare Arts & Entertainment Economic Development & Prosperity Finance & Fundraising Governance N/A
Are you interested in becoming a member of the SFBPA?

Are you interested in becoming a member of the SFBPA? Yes Not at this time
Are you interested in joining a SFBPA working committee? Please select no more than (2) committees.

Are you interested in joining a SFBPA working committee? Please select no more than (2) committees. Education Youth Development Government Affairs & Advocacy Outreach & Membership PR/Marketing & Communications Healthcare Arts & Entertainment Economic Development & Prosperity Finance & Fundraising Governance Not interested at this time
Dietary Restrictions

Dietary Restrictions None Vegetarian Vegan
Please indicate your method of participation?

Please indicate your method of participation? In-Person (According to current CDC Social-Distancing Guidelines) Virtual via ZOOM (link will be provided 48 hours prior to event)
Photographic/Film Consent & Release Notice

Photographic/Film Consent & Release Notice I hereby give my consent to the South Florida Black Prosperity Alliance (“SFBPA”) to: (a) record my likeness and voice on a video, audio, photographic, digital, electronic or any other medium and to use my name in connection with these recordings; and (b) to use, reproduce, exhibit or distribute these recordings in whole or in part in perpetuity in any and all media throughout the universe (including but not limited to print publications, video tapes, non-theatrical, home video, CD-ROM, internet and any other electronic or other medium presently in existence or invented in the future) for any purpose that SFBPA, and those acting pursuant to its authority, deem appropriate, including promotional, recruiting, advertising and any commercial or non-commercial use. I hereby release [production company, if applicable] and SFBPA from and against any and all claims, demands, actions, causes of actions, suits, costs, expenses, liabilities, and damages whatsoever that I may hereafter have from liability for any violation of any personal or proprietary right I may have in connection with such use of my likeness, voice, or name in any medium, and expressly waive any rights to privacy I may have under the Family Educational Rights and Privacy Act ("FERPA") and/or §1002.22, Fla. Stat. I understand and agree that all such recordings, in whatever medium, shall remain the property of the SFBPA. I have read and fully understand the terms of this release. I do not consent to the Photographic/Film Consent & Release