POCIS Upper School Conference Registration Form
Service Learning as Racial Justice?:  "Who's Servin' Whom?"
A high school student conference with workshop tracks for adults.

Saturday, October 6, 2010
2:30 p.m. – 8:30 p.m.
Lick Wilmerding High School
755 Ocean Avenue, San Francisco, 94112

Free for POCIS Gold Member Schools
$20 for POCIS Posting Member Students
$50 POCIS Posting Member School Adults
$25 for non member students
$75 for non member adults

*No student or student family member(s) will be turned away for lack of funds.

Please make checks payable to: POCIS of Northern California

Checks may be submitted on the day of conference or mailed in advance to:
POCIS of Northern California
P.O. Box 18828 Oakland, CA 94619

For questions with registration please contact registration@nocapocis.org
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Adult Information
Please fill out this section if you are an adult or chaperone attending the conference.

Chaperones, please also fill out the student information section.

If you are a student, please fill out the student information section.
Adult/Chaperone Last Name
Adult/Chaperone First Name
Adult/Chaperone School/Organization
Adults, please check all that apply
Adult/Chaperone Email
Adult/Chaperone Phone Number
Adult/Chaperone Ethnic Identity
Student Information
If you are a student registering yourself please fill out the information below.

If you are an adult chaperoning a high school student, please fill in their information below.
Student Last Name
Student First Name
Student School
Student Grade
Clear selection
Student Email
Student Ethnic Identity
Parent/Guardian Name
Parent/Guardian Email
Parent/Guardian Phone Number
Clear form
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