login 

Conference Registration
 
 

 

 

Student Registration

Complete the form below to register yourself for the 2010 La Raza Youth Leadership Conference.  The registration fee is $15.00 if paid before April 10th, 2010, 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 2010 Leadership Conference scheduled for April 24, 2010, 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) 


Some of the features of this site rely on popup windows. If you are using a popup blocker, you must set it to allow popup windows from this site.  This site does not contains any advertisements or malicious popup windows. 

| HOME | SUPPORT | VOLUNTEERS | CONTACT US |
LRYLC
PO Box 8571
Denver, CO 80201

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