Register As Exhibitor

Zack Orengo2026-01-19T19:02:26+00:00

FORM 4: Panelist / Facilitator / Security Personnel Registration Form

Important Information:

Participation is voluntary. Your responses will be used to organize the event, ensure accessibility, and communicate with you about your role.

Section A: Participant Role

Tick all that apply

PanelistFacilitatorModeratorSecurity Personnel

Programs / Festivals

Mashujaa – Black History Beyond FebruaryCanada–Africa Heritage and Cultural FestivalHarambeecouver Arts and Reconciliation Festival

Section B: Basic Information

Full Legal Name

Preferred Name / Company / Professional Title

Email

Phone Number

City

Province

Section C: Professional / Community Information

Area of Expertise / Professional Experience

Languages Spoken

Do you identify as part of an equity-deserving community?

Black / African / African DiasporaIndigenousRacializedNewcomer / RefugeePerson with a disabilityLGBTQ2S+Interfaith or Faith-Based MinorityNot part of an equity-deserving groupOtherPrefer not to say

Section D: Accessibility and Support Needs

MobilityHearingVisualLanguage (Sign) / InterpretationOther

If Other, please specify

Section E: Role-Specific Details

Panelist / Facilitator / Moderator / Trainer

Topic / Session Title

Brief Description of Presentation / Session

Preferred Session Length

30 min45 min60 min90 min

Technical / AV / Presentation Needs

Security Personnel

Availability Dates

Times

Experience / Qualifications (optional)

Specific Duties / Locations (if assigned)

Section F: Consent, Media, and Participation Terms

Media and Documentation ConsentVoluntary ParticipationEvent Changes or CancellationAttendance and PunctualityGood-Faith Participation

Section G: Declaration

Your Full Name

I confirm that the information I have provided is true and complete.

Signature (Type Name)

Date