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
http://ncejn.org/
Contact ncejsummit@gmail.com with questions.
First Name *
Your answer
Last Name *
Your answer
School Affiliation? *
What academic institution are you affiliated with (e.g., college, university, vocational, or professional)?
Your answer
Email Address *
Please provide a working email address so we may verify your registration with you.
Your answer
Mailing Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Phone *
e.g., 999-999-9999
Your answer
Fax
Your answer
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.
Method of Payment *
Please make check or money order to NCEJN.
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.
Roommate Gender Preferences *
If you would prefer to have a roommate of the same gender, please indicate below.
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.
Your answer
Do you have any dietary restrictions?
Please detail.
Your answer
Will you need child or adult care?
Please provide ages.
Your answer
How did you learn about the EJ Summit?
I approve of being photographed or filmed at the 2016 EJ Summit. *
Submit
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