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2017 Cities United Regional Convening in Durham

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REGISTRATION

Please complete the form below to register to attend:

Please correct the field(s) marked in red below:

1
Contact Name
 *
Contact Name
2
Email
 *
3
Contact Number
4
Is this a Mobile Device?
Is this a Mobile Device?
5
Address
Address
6
Institution/Organization: My Brother's Keeper or Cities United
7
I plan to attend sessions on
 *
I plan to attend sessions on
8
I plan to attend the closing dinner and networking session on Tuesday March 14th at 6pm.
 *
I plan to attend the closing dinner and networking session on Tuesday March 14th at 6pm.
9
Do you have dietary restrictions? 
Do you have dietary restrictions?
10
If yes, please specify
11
Will you require special ADA accommodations? 
Will you require special ADA accommodations?
12
If yes, please specify
  1. To receive a copy of your submission, please fill out your email address below and submit.