2016 Indiana Delegates to National Convention Registration Form  
Salve!  Thank you for visiting this form.

If you have already registered for the NJCL National Convention, please continue.

If you have not registered, please read through the materials at http://www.njcl.org/pages/convention-registration, complete your registration, and then come back here to complete this form.

Remember that you are supposed to request and pay for the pre-convention housing option when you register.

In addition to the national fees, you will also need to pay $30.00 to the Indiana JCL to pay for your state supplies.  After completing this form, you will receive a form via email with payment addresses and other important things to remember.

Costs involved:

$495--NJCL Convention Registration--paid to NJCL at time of registration
$55--NJCL Convention Pre-Housing Option--paid to NJCL at time of registration (includes housing and two meals)
$30--IJCL State Delegate Fees--paid to IJCL after registering (includes picnic, two state shirts, state spirit, pre-convention meal)

If you have questions, please don't hesitate to email chair@ijcl.org to ask.

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First name *
Last name *
Age *
Gender *
Date of Birth *
You can type the date in if you don't want to use the calendar button.
Street Address *
City *
State *
Please use the two letter format.
Zip Code *
Participant Email Address *
Parent Email Address (if a student)
Participant Cell Phone Number *
Use this format: xxx-xxx-xxxx
Parent Cell Phone Number
For students only.  Please use this format: xxx-xxx-xxxx
Home Phone Number *
Use this format: xxx-xxx-xxxx
T-Shirt Size *
You will receive two state t-shirts as part of your convention experience.
Please list any allergies or dietary requirements. *
If you do not have any allergies or dietary requirements, type "none".
Chapter *
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