2021 Virtual Becca Conference Registration

$200 for a group of 2. Each additional person is $50 up to 8 registrants.

$200 for up to 2 registrations
$250 for 3 registrations
$300 for 4 registrations
$350 for 5 registrations
$400 for 6 registrations
$450 for 7 registrations
$500 for 8 or more registrations

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Email *
Main Contact - Name *
How many attendees are you registering? *
Is anyone in your group a presenter? If yes, please email becca@ccyj.org with their contact information and do NOT add them to this form. *
How would you like to pay for your registration? An invoice will be sent to the email address entered at the top of this form. *
What is the name of your company, organization, or school district? *
What county is your organization in? *
How did you hear about the Becca Conference?
Have you or anyone in your organization previously attended the Becca Conference? *
Would you or anyone in your organization like to be part of the Becca Task Force? *
Conference Attendees
If you are filling out this form on behalf of others, please do not include your information below. If the person filling out this form is attending the conference, please include your name below. Please enter the attendees' full name and email address.

All conference materials and virtual conference links will be sent directly to the email addresses below after the registration invoice is paid.
#1 - Name
#1 - Email Address
#2 - Name
#2 - Email Address
#3 - Name
#3 - Email Address
#4 - Name
#4 - Email Address
#5 - Name
#5 - Email Address
#6 - Name
#6 - Email Address
#7 - Name
#7 - Email Address
#8 - Name
#8 - Email Address
#9 - Name
#9 - Email Address
#10 - Name
#10 - Email Address
By submitting this form, I understand that I can edit my registered attendee(s) information until October 1, 2021 by emailing becca@ccyj.org. ALL refunds will have a 5% service fee deducted from the refund amount. No refund of registration fees will be given after October 1, 2021. *
A copy of your responses will be emailed to the address you provided.
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