Event Registration Form

1. Contact Information

First Name *

Last Name *

Name as you would like it to appear on name badge *

Email *

Cell Phone * (xxx-xxx-xxxx)

Address *

City *

State (Scroll and select one.) *
---ALAKASAZARCACOCTDEDCFMFLGAGUHIIDILINIAKSKYLAMEMHMDMAMIMNMSMOMTNENVNHNJNMNYNCNDMPOHOKORPWPAPRRISCSDTNTXUTVTVIVAWAWVWIWY

Zip *

Gender (Scroll and select one.)
---FemaleMale

Emergency Contact Person *

Emergency Phone * (xxx-xxx-xxxx)

2. Ministry Information

Your Ministry/Community Affiliation (Scroll and select one.) *

---Archbishop Rummel High School, Metairie, LABrother Charles Crouzet Community, Covington, LACathedral High School, El Paso, TXCathedral High School, Los Angeles, CACentro La Salle Community, Tijuana, MexicoChristian Brothers High School, Sacramento, CAChristian Brothers School, New Orleans, LACristo Rey De La Salle East Bay High School, Oakland, CADe La Salle Academy, Concord, CADe La Salle High School, Concord, CADe La Salle High School, New Orleans, LADe La Salle Institute, Napa, CADe La Salle North Catholic High School, Portland, ORDe Marillac Academy, San Francisco, CAHilary House Community, Santa Fe, NMHoly Family Community, Napa, CAHoly Family Community, Lafayette, LAJoseph Alemany Community, Moraga, CAJustin-Siena High School, Napa, CALa Salle Catholic College Preparatory, Milwaukie, ORLa Salle High School, Pasadena, CALa Salle High School of Yakima, Union Gap, WALa Salle Vietnam House, San Jose, CALewis University-Albuquerque, NMMullen High School, Denver, COProvincialate Community, Napa, CASacred Heart Cathedral Preparatory, San Francisco, CASaint Mary’s College High School, Berkeley, CASaint Mary’s College of California, Moraga, CASan Miguel High School, Tucson, AZSt. Michael’s High School, Santa Fe, NMSt. Paul’s School, Covington, LAOther

If you are a student, scroll and select one. *

---High School FreshmanHigh School SophomoreHigh School JuniorHigh School SeniorCollege FreshmanCollege SophomoreCollege JuniorCollege SeniorN/A

If you are an adult, scroll and select one. *

---School PresidentSchool PrincipalFaculty/StaffLasallian VolunteerBoard ChairBoard TrusteeBoard Trustee CandidateBoard Recording SecretaryDistrict LeadershipEvent StaffN/A

3. Event Information

Scroll and select one. *

---April 2-4, 2019: Discerning Leaders, Napa, CAApril 28-30, 2019: Local Formation Coordinators Gathering, Mont La Salle, CAMay 13-15, 2019: Board Governance Training, Napa, CAJune 17-20, 2019: District Chief Administrators Association Meeting, Napa, CAJune 19-21, 2019: Association of Board Chairs Meeting, Napa, CA

4. Rooming

I will need a room on the following event nights. (Check one.) *

All event nightsNo event nightsAll event nights except first nightAll event nights except last night

5. Meals

Scroll and select one. *

---All event mealsNo event mealsAll event meals except indicated below:

Meals I will not need (i.e. last day box lunch) (If none, enter n/a.) *

Special dietary needs (If none, enter n/a.) *

6. Flight Information (if applicable)

Air arrival (date/airline/flight number/time)

Air departure (date/airline/flight number/time)

7. Needs/Permissions

Any other special needs or information (If none, enter n/a.) *

Events Photography/Video Policy (Check box to acknowledge) *

By attending this event and its activities, participants understand that their image may be captured by District of San Francisco New Orleans and may be used without compensation in photographs, videotapes, motion pictures or any other recordings or other record of this event that contains that image for any purpose, including for future advertising for the event.

8. Verify & Submit Registration *