Organization Registration | CB14 Youth Conference 2018

Organization*

Contact Person*

First Last

Email*

Enter Email Confirm Email

Phone*

Website

Please enter your website with http:// or https:// in front of the domain (i.e. http://yourwebsite.com or https://yourwebsite.com). Otherwise, if you don't have a website, please leave this field blank.

Website

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Company Logo

Please upload a version of your logo that we can use on promotional materials, such as our website, printed flyers to indicate your participation. Must be in JPG, PNG, or GIF format. Email [email protected] if you have a different format.

Organization Overview*

Please provide a brief description of your organization's vision/mission to help inform students and parents.

What kinds of opportunities can you offer young adults between the ages of 12 and 21?*

Hold the Command key (Mac) or the Control key (PC) to select multiple options.

Other opportunity*

What areas of interest do you operate in?*

Hold the Command key (Mac) or the Control key (PC) to select multiple options.

Other area of interest*

What ages do you offer opportunities for?*

Please select all ages that qualify for the opportunities you provide.

Terms of Agreement

By filling out this form, you agree to host an information table with at least one representative from your agency, organization or business at the CB14 Youth Conference at the Flatbush YMCA on March 15th, from 4-7 PM. Representatives must arrive by 3 PM for set-up on the day of the event and must agree to remain until the end of the event at 7 PM. Representatives should expect at least 500 students to attend and should prepare materials accordingly. Please call CB14 at 718-859-6357 if you have any questions or concerns.

Do you agree to these terms?*

I agree.

Organization Portfolio Item Title

Organization Description

Item Category