Registro/Registration Form- Pilsen Education Summit 2017
"Celebrando Pilsen/Celebrate Pilsen"
Benito Juarez Community Academy
Sábado 21 de Octubre, 2017/ Saturday, October 21, 2017
8:00am-2:00pm

El ultimo dia de registracion es el 18 de Octubre/The last day for registration is October 18th/

Email address *
Nombre de Padre(s) que asistirán/Parent(s) name who will be attending:
Your answer
# de Niños (5-13 años)/# of Kids (5-13 years old):
Your answer
# de adultos/# of adults:
Your answer
Domicilio/Address:
Your answer
Código Postal/Zip Code:
Your answer
Número de Teléfono/Telephone Number
Your answer
Escuela o Organización que lo registró/School or organization who registered you:
Your answer
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