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Conference Registration

 
 

 

 

Student Registration

Complete the form below to register yourself for the 2019 La Raza Youth Leadership/Servicios de la Raza Conference.  The registration fee is $15 if paid by Saturday, April 6, 2019, and $25 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.)

 T-shirt size (adult sizes)?
 

 Might this student be eligible for the Free and Reduced Lunch program?
 

I request a Spanish language program for the day of the conference.

I request a language interpreter for the day of the conference.
     Service description: 

I have a disability and request a reasonable accommodation for the day of the conference.
     Accommodation request:   

  

Photography Release Statement

This confirms the agreement between you and La Raza Youth Leadership/Servicios de la Raza Institute (LRYLI), regarding your participation in the 2019 Leadership Conference scheduled for Saturday, April 13, 2019, in which you may be photographed or videotaped.

You hereby agree that LRYLI may use these photographs/video on its website or in other official printed publications without further consideration.  You authorize LRYLI to use and share your picture for promotional purposes with partners and sponsors of the event.

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

You also acknowledge that LRYLI 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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Servicios de La Raza/LRLYC
3131 W. 14th Avenue
Denver, CO 80211

Copyright 2006
La Raza Youth Leadership
Institute
Phone: (303) 458-5851
StephenD@serviciosdelaraza.org