Student Work Exchange Registration for 2016 EJ Summit (online form)
18th NCEJN EJ Summit Registration (STUDENT WORK EXCHANGE -- Only offered to those students (e.g., college, university, vocational, or professional) who cannot subsidize the General Registration costs from other funding sources. Registration costs will be a flat fee of $50 plus volunteering at the 2016 EJ Summit.)
Environmental Justice: Moving Beyond Electoral Politics and Toxic Representation
October 21-22, 2016
What academic institution are you affiliated with (e.g., college, university, vocational, or professional)?
Please provide a working email address so we may verify your registration with you.
Student Work Exchange Registration Type
Only offered to those students (e.g., college, university, vocational, or professional) who cannot subsidize the General Registration costs from other funding sources. Registration costs will be a flat fee of $50 plus volunteering at the 2016 EJ Summit.
Friday only ($50 + volunteering at 2016 EJ Summit)
Saturday only ($50 + volunteering at 2016 EJ Summit)
Friday + Saturday ($50 + volunteering at 2016 EJ Summit)
Method of Payment
Please make check or money order to NCEJN.
PayPal (Go online to
to PayPal NCEJN. Please include a note informing us what your payment is for, e.g., Friday only Summit)
Check (Mail to: P.O. Box 68, Rocky Mount, NC 27802)
Money Order (Mail to: Box 68, Rocky Mount, NC 27802)
Do you need lodging at the Franklinton Center on Friday night?
PLEASE NOTE: Lodging at the Franklinton Center will be reserved for those requesting the Impacted Community Scholarship and the Student Work Exchange until September 30, then available rooms will be opened up to General Registrants (i.e. lodging is not guaranteed after September 30). All Franklinton Center rooms will have at least 2 people per room. All registrants that have requested lodging at the Franklinton Center must notify the Coordinators by October 10 if lodging is no longer needed; otherwise, we will ask you to pay $25 for the dorm room and $40 for the hotel-style room.
No, thank you.
Roommate Gender Preferences
If you would prefer to have a roommate of the same gender, please indicate below.
Not applicable - NO LODGING NEEDED
Name of Roommate Preference
Leave blank if not applicable. You may request up to 1 roommate. The dorm style rooms have two twin-size beds with a shared bathroom in the hallway.
Do you have any dietary restrictions?
Will you need child or adult care?
Please provide ages.
How did you learn about the EJ Summit?
NCEJN Facebook page
Online, not through NCEJN's sites
From a friend or family member
From my community organization
From a listserv email
From a flyer
I approve of being photographed or filmed at the 2016 EJ Summit.
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