2018 Cyber Crime Prevention Symposium X Registration Form
Location: California Endowment
Date: Monday, October 15, 2018

For any questions about this event please contact
Donna Uy-Barreta at m.donna.uy-barreta@lacity.org.

Email address *
First Name *
Your answer
Last Name *
Your answer
Address *
Your answer
Telephone *
Your answer
Name of School/Organization *
If school, please indicate Middle or High School.
Your answer
Position *
Choose one.
Required
How Many Students will be Attending? *
Max. # of student attendees per school is 7. If no students are attending, please enter 0.
Your answer
First and Last Name/Grade of Student(s) Attending (Grade Order) *
Max. # of student attendees per school is 7. If no students are attending, please enter 0. If no students are attending, please enter none.
Your answer
How Many Adults? *
Max. # of adult attendees is 4. If you are attending, please include yourself.
Your answer
Name of Adult(s) Attending? *
Max. # of adult attendees is 4. If you are attending, please include your name. If no adults are attending, please enter none.
Your answer
Total Number of Attendees *
If attending, please include yourself.
Your answer
Have you previously attended a Cyber Crime Prevention Symposium? If so, when?
If yes, please include date you last attended.
Your answer
Will you consider having your school enter the Cyber Crime Challenge?
SPECIAL NOTE:
Each year there is a lengthy waiting list to attend. Therefore, please understand that your registration is a commitment to attend. If for some reason you cannot attend after you have registered, please inform us one week in advance so that others on the waiting list have the opportunity to attend this important educational event.

Also, by registering for the Symposium, you are granting the hosting agencies permission to take, use, reuse and publish photographs and/or videos of attendees in any and all of its publications and in any and all other media, including but not limited to use and publication on the Internet, webpages and social media accounts.

Thank you in advance for your prompt attention to the above necessary requests.

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