Individual Registration

* Indicates required field

Name/nombre *

First

Last

Email/correo electronico *

Phone Number/numero de teléfono *

Facebook username/nombre de usuario *

Dietary Restrictions/restricciones de dieta *

Will you need childcare?/ Necesitas cuidado de niños? *

Yes/Si No/no

List names, ages, and dietary restrictions of any children. (Or if no children attending, write "none")./ Lista las nombres, edades y restricciones de dieta de sus niños. (O, si no tiene niños, pone "no aplica" *

Would you or anyone in your group benefit from translation services?/ ¿Alguien de su grupo se beneficiaría de los servicios de traducción? *

Yes, please./Si, por favor No./no

If yes, what is the primary language of those needing translation?/ En que idioma necesitas traduccion? *

How would you like to pay the $20 registration fee (scholarships available)?/Como le gustaria pagar el registro de $20? (Hay becas) *

I'd like to pay now, please! (Just follow the instructions on the confirmation page)./ Quiero pagar ahora del internet. I'd like to pay at the event. (We can take cash or check)./Quiero pagar el primer noche del evento. Scholarships are available? Yes please!/ Hay becas? Quiero informaccion por favor. I am coming as a part of a group that is covering my registration./ Estoy parte de una organizacion que esta pagando mi cuota.

Are you coming as a part of an organization, institution, or group? Please write the name of the group here./ Estas veniendo como parte de un grupo o organizacion? Favor de poner el nombre del grupo aqui. *

Are you able to attend all sessions? (Check all that apply)/ Puedes asistir a todas las sesiones? Marque todo lo que corresponda. *

Yes!/ Si! I will be absent for Session 1/ Voy a estar ausente la primera sesion.. I will be absent for Session 2/Voy a estar ausente la segunda semana. I will be absent for Session 3/ Voy a estar ausente la tercera semana. I will be absent for Session 4/Voy a estar ausente la cuarta semana.

I would like you to make it easy for me to invite others in my community or organization. *

Yes! Please send me a flyer that I can post or email to others. Yes! Please tag me on social media posts so I can share easily without added work! No, thanks!

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Individual Registration

Email

phone