Within Our Reach Conference: Registration Form
Information:
School/Organization: _________________________________________________________________
Please check one: □ Educator □ Parent □ other: _______________________________________
A.) Accompanying students: Yes____ No____ (If No, then proceed to Contact Information)
B.) If Yes to question A, then will you and your group travel by bus? Yes____ No_____
C.) If No to question B, then please use Parking structures 2 and 3 ( $8.00 per car to park).
D.) Note: If you are bringing students, then please have all student attendees complete the student waiver form (to be returned on the day of the conference).
Contact Information:
Mailing Address: ________________________________________________________
City: __________________________State: _______ Zip: ________________________
You may submit your registration via email: WithinOurReach@gmail.com ,
phone: (310) 686-0386 or fax 310. 267.4446 .
*Please copy and paste this form when sending via email*
We look forward to seeing you at the Conference!
The Within Our Reach Planning Committee