The 21st Annual National Service-Learning Conference

Your registration is complete when your credit card has been processed. Incomplete registrations will not be accepted.

Pre-registration is available online only through March 4, 2010.

Please complete a separate registration for each individual attending.

Please complete the registration information below.
* indicates required field.

BASIC INFORMATION

Online registration requires Visa, MasterCard, or American Express.

First Name

Last Name

School/Organization as it should appear on badge

Title

Confirm Email

Phone
(xxx-xxx-xxxx)

Phone Extension

Fax
(xxx-xxx-xxxx)

Address

Address Line 2

City

State

Province/District

Country

Postal Code
(where applicable)

What kind of address is this?

Please select the options that best describe you.
(Select all that apply. Hold down the 'Ctrl' key to select multiple options.)

Please sign me up for NYLC e-newsletters

Are you on Twitter?

Yes

If so, what is your username:

REGISTRATION OPTIONS

Please select the type of registration you would like.

Adult Full Conference Registration	$ 625.00
Youth Full Conference Registration	$ 315.00
One Day Adult Registration	$ 315.00
One Day Youth Registration	$ 175.00
Presenter Full Conference Registration	$ 625.00
Presenter Only	Complimentary
Exhibitor Full Conference Registration (complimentary with exhibitor code)	$ 575.00
Exhibit Hall Access Only	Complimentary
Administrator's Academy Only	$ 79.00
Adult Committee Member Full Conference (code required)	$ 395.00
Youth Committee Member Full Conference (code required)	$ 265.00

Exhibitor or Discount Code
(if applicable)

CONFERENCE MEALS

All Full Conference Registration Fees include the following meals:

• Wednesday, March 24: Welcome Celebration
• Thursday, March 25: continental breakfast and box lunch
• Friday, March 26: continental breakfast, box lunch, State Farm Awards Celebration
• Saturday, March 27: continental breakfast and lunch

Dietary Needs *

Regular Meals

Vegetarian Meals

Vegan meals and special dietary meals are not provided by the conference. All food items are labeled for your convenience.

SPECIAL EVENTS RSVP

Admittance to these events is included with conference registration. To assist in planning we ask that you RSVP below:

I will attend the Wednesday Night Welcome Reception and Exhibit Hall Grand Opening.

	Yes
	No

I will attend the Learn and Serve America Fireside Chat on Wednesday Night.

	Yes
	No

I will participate in the Administrators Academy on Thursday

	Yes
	No

I will attend the Friday Night State Farm Awards Celebration and Project Ignition Dance Party.

	Yes
	No

I will participate in the Saturday Service-Learning World Forum.

	Yes
	No

USE OF NAMES AND PHOTOGRAPHS

Attendees give NYLC permission to use their names, and photographs, video, and audio recordings taken of them during the conference for promotional and educational purposes.

Please check the box to indicate that you agree with the names and photographs policy.

I agree with the above policy.

Email Registration Assistance

The 21st Annual National Service-Learning Conference® is a program of NYLC, with lead sponsorship by the State Farm Companies Foundation, host sponsorship by the Shinnyo-en Foundation, and in collaboration with a number of national and international organizations.

K-12 School: Administrator
K-12 School: Community Education Staff
K-12 School: Service-Learning Coordinator
K-12 School: Teacher (Primary)
K-12 School: Teacher (Secondary)
K-12 School: Elementary Student/Youth
K-12 School: Middle School Student/Youth
K-12 School: High School Student/Youth
Higher Education: Faculty/Administrator
Higher Education: Student/Youth
Community-Based Organization: Staff
Community-Based Organization: Student/Youth
Government: Corporation for National and Community Service
Government: State Dept. of Education
Government: AmeriCorps/VISTA
Government: Volunteer Programs
Government: Student/Youth
Government: Senior Corps
Government: State Commission Staff
Other: Learn and Serve Grantee
Other: Generator School Network member
Other: Non-Governmental Organization
Other (please provide a description below)