RLC 2023 Individual Registration Form 
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General Information
First Name  *
Last Name  *
Do you have a preferred name that differs from the one written above? If so, please provide it here, as this is how it will appear on your name badge.
What gender do you identify as? *
Pronouns
Please select your position *
Are you an alternate delegate? *
What is Your Institution? *
What is your age? *
What size T-shirt would you like? *
Accommodations and Associability 
Dietary Needs: Mark any dietary needs, restrictions, and/or food allergies. If none, please leave blank. (Select all that apply)
Are there any accessibility needs that we need to be aware of throughout this conference? If so, please list them. (For example: diabetes, epilepsy, asthma, etc.)
Accommodations: If you require some form of accommodation to fully participate in the conference, please select "Yes" below and email ma_conf@nacurh.org with the Subject Line, "RLC 2023 Accommodations" to provide more details. This information must be sent my registration deadline to ensure that all accommodations can be made. *
Housing 
PLEASE READ CAREFULLY: Gender-inclusive housing means that students from all gender identities and expressions may opt-in to room together. Please note that this means that you may be rooming with people of any gender from other institutions as well. Would you like to opt into gender-inclusive housing? *
Emergency Contact Information
Name of emergency contact *
Relationship to the attendee *
Primary Phone Number  *
Secondary Phone Number (not required)
Insurance Company  *
Policy Number  *
Insurance Company Phone Number  *
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