PACURH RLC 2025 Registration

PACURH RLC 2025 Registration
🌟 Welcome to PACURH Regional Leadership Conference Registration 🌟

Thank you for taking the time to register for the 2025 PACURH Regional Leadership Conference, we’re so excited to see you in San Diego this November!

Please review the following registration pricing options before you begin:
⭐ Quad (4 per room): $400USD per person
⭐ Double (2 per room): $500USD per person
⭐ Single (1 per room, advisor priority): $700USD per person

Gender Inclusive Housing will be provided through an opt in process. By opting into Gender Inclusive Housing, the PACURH Conference Staff will not take gender into account when assigning rooms. Priority will be given to placing students from the same delegation in housing together and to place delegates into rooms with genders or individuals that they feel comfortable rooming with (a waiver must be completed if this option is selected)

Note: Please fill this out once per institution

This form will accept up to 10 delegates per institution, however, since there is currently no delegate cap this year we encourage you to submit this form twice if you're sending more than 10.
Personal Information (Who's submitting this form?)
Name

First NameLast Name
Email
example@example.com
Institution
Position

Advisor Information
Advisor Name

First NameLast Name
Advisor Email
example@example.com
Advisor Pronouns
Advisor Dietary Restrictions or Accessibility Needs
Advisor Room Preference (single/double/quad)
Opt-In to Gender Inclusive Housing?

Opt-In
Would you like to add an additional advisor?

YesNo

Secondary Advisor
Advisor Name

First NameLast Name
Advisor Email
example@example.com
Advisor Pronouns
Advisor Dietary Restrictions or Accessibility Needs
Advisor Room Preference (single/double/quad)
Opt-In to Gender Inclusive Housing?

Opt-In

Delegate Information
Name of NCC (or equivalent)

First NameLast Name
NCC Email
example@example.com
NCC Pronouns
NCC Dietary Restrictions or Accessibility Needs
NCC Room Preference (single/double/quad)
Opt-In to Gender Inclusive Housing?

Opt-In
Name of RHA President (or equivalent)

First NameLast Name
RHA President Email
example@example.com
RHA President Pronouns
RHA President Dietary Restrictions or Accessibility Needs
RHA President Room Preference (single/double/quad)
Opt-In to Gender Inclusive Housing?

Opt-In
Name of NRHH President (or equivalent)

First NameLast Name
NRHH President Email
example@example.com
NRHH President Pronouns
NRHH President Dietary Restrictions or Accessibility Needs
NRHH President Room Preference (single/double/quad)
Opt-In to Gender Inclusive Housing?

Opt-In
Add another delegate?

YesNo (continue to submit form)

Name of Delegate

First NameLast Name
Delegate Email
example@example.com
Delegate Pronouns
Delegate Dietary Restrictions or Accessibility Needs
Delegate Room Preference (single/double/quad)
Opt-In to Gender Inclusive Housing?

Opt-In
Add another delegate?

YesNo (continue to submit form)

Name of Delegate

First NameLast Name
Delegate Email
example@example.com
Delegate Pronouns
Delegate Dietary Restrictions or Accessibility Needs
Delegate Room Preference (single/double/quad)
Opt-In to Gender Inclusive Housing?

Opt-In
Add another delegate?

YesNo (continue to submit form)

Name of Delegate

First NameLast Name
Delegate Email
example@example.com
Delegate Pronouns
Delegate Dietary Restrictions or Accessibility Needs
Delegate Room Preference (single/double/quad)
Opt-In to Gender Inclusive Housing?

Opt-In
Add another delegate?

YesNo (continue to submit form)

Name of Delegate

First NameLast Name
Delegate Email
example@example.com
Delegate Pronouns
Delegate Dietary Restrictions or Accessibility Needs
Delegate Room Preference (single/double/quad)
Opt-In to Gender Inclusive Housing?

Opt-In
Add another delegate?

YesNo (continue to submit form)

Name of Delegate

First NameLast Name
Delegate Email
example@example.com
Delegate Pronouns
Delegate Dietary Restrictions or Accessibility Needs
Delegate Room Preference (single/double/quad)
Opt-In to Gender Inclusive Housing?

Opt-In
Add another delegate?

YesNo (continue to submit form)

Name of Delegate

First NameLast Name
Delegate Email
example@example.com
Delegate Pronouns
Delegate Dietary Restrictions or Accessibility Needs
Delegate Room Preference (single/double/quad)
Opt-In to Gender Inclusive Housing?

Opt-In
Add another delegate?

YesNo (continue to submit form)

Name of Delegate

First NameLast Name
Delegate Email
example@example.com
Delegate Pronouns
Delegate Dietary Restrictions or Accessibility Needs
Delegate Room Preference (single/double/quad)
Opt-In to Gender Inclusive Housing?

Opt-In
Add another delegate?

Yes (please contact pa_communications@nacurh.org to do so)No (continue to submit form)

Conference T-Shirt
Our institution would likeblank S shirts

Our institution would likeblankM shirts

Our institution would likeblank L shirts

Our institution would likeblankXL shirts

Our institution would likeblank XXL shirts

Our institution would likeblank XXXL shirts
Conference Housing
Our institution would likeblank quad rooms

Our institution would likeblank double rooms

Our institution would like blank single rooms
Anything else you'd like us to know? Please list any specific to housing requirements or policies from your institution that may impact conference housing.
Thank you for registering for PACURH's Regional Leadership 2025!!

Be sure to click submit at the bottom of this page and reach out to pa_communications@nacurh.org if you have any questions or concerns!!
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