2017 NCHEP Registration
Please let us know if you will be joining us in November by completing the registration form.
Name: *
Your answer
Name: *
Your answer
Title:
Your answer
Company/Organization/University Affiliation (if applicable):
Your answer
HEP Program Affiliation (if applicable):
Your answer
Mailing Address: *
Your answer
Email Address: *
Your answer
Phone Number
Your answer
How would you like your first and last name to be printed on your conference badge? *
Your answer
How would you like your professional affiliation to be printed on your conference badge?
Your answer
Which days will you be attending the conference (check all that apply)? *
Required
Please indicate the areas of programming that are most interesting to you (select no more than three): *
Required
Are you the family member or loved one of a person who is currently or formerly incarcerated?
Meals
The Alliance for Higher Education in Prison will be providing all meals (breakfast, lunch, and dinner) for participants during the conference. However, we need to know which evening meals you plan to attend. Please complete the following questions related to meals.
Which evening meal(s) will you attend? Please check all that apply. *
Required
Please list any food allergies or dietary restrictions/requirements?
Your answer
Is there anything else related to meals/food that we should know?
Your answer
If you are formerly incarcerated please complete the following series of questions. If you are not, you can skip to the end and submit your registration.
Did you participate in a higher education in prison program while incarcerated?
If yes, which program.
Your answer
Are you currently employed in the field of higher education in prison?
If yes, with which organization/program are you employed?
Your answer
Is there any other information you would like to share with the planning committee?
Your answer
Thank you for completing the registration form for the 2017 National Conference for Higher Education in Prison. By submitting this form you will be registered for the conference and you will receive email updates about the conference. If you have the financial resources to donate to the 2017 National Conference, please also complete the donation form, found on the Registration page of the conference website. If you are planning to stay at the conference hotel, please visit the Hotel and Travel page to make your reservations. We look forward to seeing you in Texas!
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