Account Registration - Individual

Thank you for joining the DEC-UVA community! You will receive a follow-up email titled "Account Registration Confirmation from Descendants of Enslaved Communities at UVA" with login instructions.

Contact Information

First Name Middle Name Last Name Birth Date (MM/DD/YYYY) / / Phone Number Phone Type Phone Number Phone Type Email Home Address Line 1 Home Address Line 2 City State/Province Zip Code - Country What is your affiliation? Please select all that apply.

Descendant of an Enslaved Person/Family

Descendant of an Enslaver

Descendant Genealogy Research In Progress

Community Member

UVA Student

UVA Faculty or Staff

UVA Alumni

Visiting Scholar or Faculty

Other/Unspecified

Skills and Interests

Do you have skills and interest in volunteering on any of the following DEC-UVA Board Committees? Select up to 2 options.

Community Engagement and Education

Fundraising, Finance, and Grants

Governance

Membership

Research and Oral Histories

Other

If you selected "Other" above, please provide additional details below.