USSA's 70th National Student Congress Individual Delegate Registration Form
Please complete this form in its entirety, to successfully register for USSA's 70th National Student Congress!
First Name *
Your answer
Last Name *
Your answer
Email *
Your answer
Phone Number *
Your answer
State or Territory *
State or territory of voter registration or if not registered to vote, state or territory of permanent residence
Your answer
Please check all the Affiliates, caucuses and or coalition you plan on attending at Congress *
Only those who identify with a particular community may attend their caucus or coalition
Required
Region *
Only those who identify with a particular community may attend their caucus or coalition
Which are you officially representing? *
Contact your delegation leader if you are unsure.
Required
School *
Your answer
Statewide Student Association *
If Applicable
Your answer
If you are interested in submitting an Administrative Resolution (AR) or Action Agenda Item (AA) at Congress, please specify the topic.
Your answer
Identity *
Please check all that apply.
Required
Gender idenity *
Please specify your gender identity and preferred gender pronouns.
Your answer
Additional Identities
Your answer
Dietary Restrictions *
Please select any dietary restrictions so we can make sure the appropriate food is ordered.
Required
Dietary Restrictions/Allergies
if you have any additional dietary restrictions and or allergies please list them below
Your answer
Please list any special needs you may require during the conference *
Your answer
Emergency Contact Information
Emergency Contact Name *
Your answer
Relationship *
Your answer
Emergency Contact Phone Number *
Your answer
Emergency Contact Address *
Your answer
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