NJ GSA Forum Group Registration
17 November 2018
9am-4pm
Middletown High School South
900 Nut Swamp Rd, Middletown, NJ 07748
More information: https://www.rustincenter.org/gsaforum/
Contact Information: RustinCenter@gmail.com
To register as an individual, please scroll to the bottom of this section and select "Next."
Name of School or Organization
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Full Name of Contact Person
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Phone Number of Contact Person
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Secondary Phone Number
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E-mail Address of Contact Person
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Address
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Names of Adults
Your answer
GROUPS PLEASE NOTE: For safety purposes, an accurate list of all participants in the group you are registering who are actually present at the Forum must be provided at the registration desk when checking in on the day of the Forum. Please respect this important request. Thank you.
Number of Students
Your answer
Please specify and give the number in your group who have dietary needs (Vegetarian, Vegan, Gluten Free):
Your answer
Please specify and give the number in your group who have accessibility needs (Mobility, Hearing, Other - please describe):
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The Forum registration fee is $10 per student and $35 per adult. No one is turned away because of inability to pay.
If you would like to request a reduced fee or waiver of fee, please indicate the number of people you are requesting for and the amount you can pay ($0, $5, or other amount)
I am requesting a reduced fee or waiver of fee. The number of students I am requesting for/the amount I can pay is:
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