1. Registration Form

Please complete the following information. Required fields are marked with an asterisk (*). Please fill in blank lines with N/A. If you have any problems with the registration form, please email leadership@nclr.org or call Berenice Bonilla at (202) 776-1741.





* 1. Name:

* 2. High School, University, College or Organization:

* 3. Are you a/an: (You may check more than one)

* 4. Permanent Address: Please fill out all lines. Please fill in blank lines with N/A.

* 5. Campus Address:Please fill out all lines. Please fill in blank lines with N/A.

* 6. Contact Information:

7. How did you hear about the Congreso?

8. Are you familiar with the NCLR Annual Líderes Summit? Check here if you are interested in being a workshop presenter, summit staff member, outreach volunteer, or if you would like to know more about the event.

Please fill in blank lines with N/A.

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