Language
English (US)
Spanish (Latin America)
Non-Member Registration Form
Your Name
*
First Name
Middle Name
Last Name
Your Organization/Company/Group
Your role/position/title
*
Type of Participant (choose one option)
*
Workshop Facilitator
Keynote Speaker
TPS Alliance Member
Corredores de Justicia Participant
Popular Education Collective
New York/New Jersey Ally
Youth Participant
Childcare Provider
Interpreter
Volunteer
Other
What is/are your pronoun(s)?
*
He/Him
She/Her
They/Them
Other
Your preferred name/nickname
Your age
*
Your Email
*
example@example.com
Your Phone Number
*
Please enter a valid phone number.
Your Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Interpretation Needs
*
Please Select
I need Spanish to English interpretation
I need English to Spanish interpretation
I want to volunteer to interpret
None
Dietary Needs
*
Vegetarian
Vegan
Kosher
Gluten-free
None
Other
If you have any food allergies, accessibility, or accommodations requests, please indicate below
How many days will you attend?
*
Asamblea is June 2 through June 7
Beginning Date
*
-
Month
-
Day
Year
Date
End Date
*
-
Month
-
Day
Year
Date
Do you require lodging?
*
Please Select
Yes
No
Please indicate below if there is someone specific you would like to room with. We will be staying in college dorm rooms where the setup are suites, either as a suite of 4 with 2 people sharing a room or a suite of 2 rooms, where each person has their own room. We will do our best to accommodate your request.
If you have any special room request due to medical or any other personal reasons, please let us know below. We will follow up with you to figure out the best way to accommodate request.
Do you require a flight?
*
Please Select
Yes
No
Please add your date of birth
*
-
Month
-
Day
Year
Date
Gender on your ID (for flights)
*
Please Select
Female
Male
Unspecified
Undisclosed
What city/state are you departing from? (Please include a preferred airport)
*
Please include name of airport if you have the information
Please indicate date of departure
*
-
Month
-
Day
Year
Date
Preferred departure time
*
Please Select
Early morning
Midday
Afternoon
Evening
Please indicate date of return
*
-
Month
-
Day
Year
Date
Preferred return time
*
Please Select
Early morning
Mid-day
Afternoon
Evening
Program ends at 1pm, suggested return flights are after 4pm on Friday, June 7th
If available, include your seat preference (please remember that your preference might not be available)
*
Please Select
Aisle
Middle
Window
If you have a flight you would like to book please add the link below, we will do our best to accommodate (please also add airline[s] and frequent flyer ID/account number[s] if you want us to register that information when booking).
Please verify that you are human
*
Submit
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