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Conference Registration
 
 

 

 

Student Registration

Complete the form below to register yourself for the 2012 La Raza Youth Leadership Conference.  The registration fee is $15.00 if paid by April 13, 2012, and $25.00 if paid after.  Registration fees are non-refundable.

You should not use this form if you wish to register a group of students for the conference.  Group registration begins here.

 

Required Information:
 
First Name: Last Name:

Reset Form 
 Age:
 		 Gender:
 
 School:
 		 Grade:
 
Address:
   
 

City: 

State:

Zip code:

 email address:
 
 Retype email address:
 
 (Note: If you do not have an email address, please enter a parent or guardian's email.)

I will require a Spanish language program for the day of the conference.
I will require a disability services while attending the conference.
 
  

Photography Release Statement

This confirms the agreement between you and La Raza Youth Leadership Institute, Inc. (LRYLI, Inc.), regarding your participation in the 2012 Leadership Conference scheduled for April 28, 2012, in which you may be photographed or videotaped.

You hereby agree that LRYLI, Inc. may use these photographs/video on its website or in other official printed publications without further consideration.

You acknowledge LRYLI, Inc.’s right to crop or treat the photographs/video at its discretion.

You also acknowledge that LRYLI, Inc. may choose not to use your photo/video at this time, but may do so at its own discretion at a later date.

I agree to these terms and conditions.
 

  
(All major credit cards accepted) 


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LRYLC
PO Box 8571
Denver, CO 80201

Copyright © 2006
La Raza Youth Leadership Institute, Inc.
Phone: 303-556-6730