Organization/Business*Contact Person* First Last Email* Enter Email Confirm Email Phone*WebsitePlease 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 AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Company LogoPlease 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/Business 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?*Career training programsCollege informationHealth informationInternshipsJobsOtherSummer/after-school activityVolunteer opportunitiesHold the Command key (Mac) or the Control key (PC) to select multiple options.Other opportunity*What areas of interest do you operate in?*Arts/EntertainmentBusiness/FinanceEnvironment/Parks/OutdoorsMedicine/HealthcareOtherPublic Service/PoliticsScience/MathTechnology/Computer and Software EngineeringTradework (construction/plumbing/mechanical, etc.)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?* 12 13 14 15 16 17 18 19 20 21 Please select all ages that qualify for the opportunities you provide.Terms of AgreementBy 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 Brooklyn College Student Center on March 11th, 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 600 students to attend and should prepare materials accordingly. Please call CB14 at 718-859-6357 if you have any questions or concerns. Please check the email address you provided above for a confirmation email, which you should receive shortly.Do you agree to these terms?* I agree. Organization Portfolio Item Title Organization/Business DescriptionItem Category-- select a Category --Organizations--10th Annual Youth Conference 2017 Organizations--11th Annual Youth Conference Organizations 2018--12th Annual Youth Conference Organizations 2019--13th Annual Youth Conference Organizations 2020Photos--10th Annual Youth Conference 2017 Photos--12th Annual Youth Conference Organizations 2019SupportersWorkshops--10th Annual Youth Conference 2017 Workshops--11th Annual Youth Conference 2018 Workshops--12th Annual Youth Conference Organizations 2019 This iframe contains the logic required to handle Ajax powered Gravity Forms. youthadminOrganization/Business Registration01.23.2017
