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Conferencia Juntos en Familia 2019 Registration/Registracion
Sabado 19 de Octubre 2019
Universidad del Sur de Oregon/Southern Oregon University
Mas informacion: 541-552-6478 o
chavezbjo@sou.edu
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* Indicates required question
First Name/Nombre
*
Your answer
Last Name/Apellido
*
Your answer
Date of Birth/Fecha de Nacimiento
*
MM
/
DD
/
YYYY
Address/Dirección
*
Your answer
City/Ciudad
*
Your answer
State/Estado
*
Your answer
Zip Code/Codigo Postal
*
Your answer
Student Email/Correo Electronico de Estudiante
*
Your answer
Parent Email/Correo Electronico del Padre/Madre
*
Don't have email/No tengo correco electronico
Other:
Required
School Level/Nivel de Escuela
*
High School/Preparatoria
Other:
School Name/Nombre de La Escuela
*
Ashland Middle School
Phoenix High School
South Medford High School
North Medford High Schoo
Ashland High School
Eagle Point High School
Crater High School
Klamath Union
Mazama
Other:
Grade/Grado
*
12th
Are you part of one of these school programs?/¿Es parte de uno de estos programas en su escuela?
*
Pirates to Raiders
Bulldogs to Raiders
Hornets to Raiders
No
Have you participated in Academia Latina? Ha participado en Academia Latina?
*
Yes/Si
NO
Required
Have you participated in the Cesar E. Chavez Leadership Conference? Ha participado en La Conferencia Cesar E. Chavez?
*
Yes/Si
NO
Required
Have you participated in the Latino Family Day Conference? Ha participado en La Conferencia Dia Familiar Latino?
*
Yes/Si
NO
Required
Number of adults attending/Numero de acompañantes adultos
*
Your answer
Do you need childcare?/¿Necesita cuidado de niños?
*
Yes/Si
No
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