Urban Congress General Convening
Saturday, April 13, 2019
8:30am - Check In and Breakfast
9:00am- General Covening
12:00pm- Closing Lunch

McKinley Alumni Center
1520 Thomas Delpit
Baton Rouge, LA 70802

***********************************************SEATING IS LIMITED********************************************************

Please be aware that by completing this form you are registering as a "delegate" to the Urban Congress on African American Males in Baton Rouge. As a delegate you represent a constituency, either your community or your organization. Your responsibility is to ensure the voice of your constituency is expressed during the work of the Congress. You also agree to be present, prepared and participate for the entirety of the April 13th convening.

Email address *
First Name *
Your answer
Last Name *
Your answer
Address
Your answer
Phone Number *
Your answer
Are you an African American Male?
Which of these best represents your affiliation?
Organization Name (if applicable)
Your answer
Please select the goal you would like to work towards achieving. *
Would you like to receive email updates and information regarding future activities and events? *
Submit
Never submit passwords through Google Forms.
This form was created inside of MetroMorphosis. Report Abuse - Terms of Service