NEJ BMCR 53rd Annual Meeting Registration
Sign in to Google to save your progress. Learn more
Email *
Title *
Name *
Address *
Phone Number *
Email Address *
Please indicate *
Required
Local Caucus *
Annual Conference *
Are you? *
Required
How will you attend? *
Required
Registration Fee *
Required
Dietary restrictions (for in person meals) *
Required
Scan QR Code below to remit registration fee via Zelle. You will need to search for your bank name and proceed with the instructions on the screen. 

Registration payment may also be made via Zelle to nejbmcr.treasurer@gmail.com or via check to made payable to NEJ BMCR. Please send checks to Gail Douglas-Boykin, NEJ BMCR Treasurer, 3701 Avenue I (i), Brooklyn, NY 11210-4331

Please insure that your name and local caucus are indicated with your payment. 

Your cooperation is greatly appreciated.
*
Captionless Image
Required
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy