Preventing Gun Violence Conference Registration
FRIDAY, OCTOBER 25, 2024, 8:00 am - 1:00 pm 
Event Address: Rivers Club 301 Grant Street, Ste 411 Pittsburgh, PA 15219
Contact us at (412) 304-4676 or KevinCooperMinistries8KEC@gmail.com
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Please select your registration type.  *
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First Name  *
Last Name  *
Mailing Address (including zip code):
Phone Number: *
Name of Organization:
Professional Role:
What community do you represent?  *
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How did you learn about the conference?  *
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Dietary restrictions: *
I understand the registration fee of $150.00 ($250.00 AFTER September 1, 2024) must be paid by October 25, 2024, for all attendees. *
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I agree to pay the registration fee with: (please select one of the following options): *
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Are you requesting assistance with the registration fee? 
I give permission for images of myself captured during the KCM Preventing Gun Violence Conference through video, photo, and digital camera to be used solely for the purpose of Kevin Cooper Ministries' promotional materials.  *
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I give KCM permission to add my email to a mailing list solely for the purpose of Kevin Cooper Ministries' program notifications.  *
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