2013 Southern Harm Reduction and Drug Policy Conference

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The 2013 Southern Harm Reduction Conference will take place on December 12 + 13, 2013 in New Orleans.
Location: HYATT REGENCY NEW ORLEANS, 601 Loyola Avenue, New Orleans, LA 70113

Please press submit when you have completed the application

What is your last name? *

What is your first name? *

What is your state of residence? *

What is your email? *

What is your phone number? *

What is your address? *

Please provide street address, city, state and zip

What organization or group are you affiliated with? *

What is your gender *

Male

Female

Transgender M to F

Transgender F to M

Other:

How did you hear about the event?

How do you plan on paying for the conference? *

The conference is $60 by cash or check and $63 via paypal (Paypal charges us a usage fee)

Paypal (Please make a $63 donation to North Carolina Harm Reduction Coalition)

Check made out for $60 to North Carolina Harm Reduction Coalition

I am a conference organizer and exempt from payment

I am going to apply for a scholarship

Scholarship Applicants Only: Please let us know in under 100 words why you need a scholarship

Scholarship are available to people of the South only. Priority will be given to drug users, sex workers, people with a history of incarceration and people of transgender experience.

Scholarship Applicants Only: Please let us know what assistance you need....Check all that apply

Conference fee waiver

Housing

Conference fee waiver and housing

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