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2022 Reentry Conference & Resource Fair Registration
Free Admission, Continental Breakfast, Lunch and Parking
(please
see
Event Map and Directions
)
First Name:
*
Last Name:
*
Contact Phone Number:
*
Email contact:
*
Please confirm your email
*
Website (if you have one):
I learned about the Reentry Conference and Resource Fair through?
*
I'm attending the Conference and Resource Fair as a:
*
Attendee only
Volunteer (to help support this event) *
Speaker: Moderator or Presenter (invited by the Restorative Justice Ministry)
Resource Fair Exhibitor (I'm reserving a table for agency, organization or 2nd chance employer)
Crime Survivor (reserving a table for Shrine of Remembrance)
* Volunteer opportunities include outreach, setting up, registration, assisting during the event in various capacities and cleaning up.
*
Volunteer outreach before the event (before the event).
Volunteer the day before the event (1:00 p.m. to 4:00 p.m.)
Volunteer during the event (7:00 a.m. until 3:00 p.m.)
Volunteer to clean up after the event same day (3:00 p.m. to 5:00 p.m.)
Please specify the name of the panel that you are moderating or presenting on, approved by Julio Escobar.
*
We ask that all speakers participating in panel discussions dress professionally. Do you accept?
*
Yes.
Are you representing an organization?
*
Yes
No
Volunteer Comments (optional):
Agency, Organization, or Employer name
*
Contact's name (Responsible for exhibitor's table)
*
Contact Phone Number
*
Your Title or Position
*
Website link:
*
Street Address
*
City
*
State
*
Postal Code
*
Will there be more than one person sitting at your exhibitor's table?
*
Yes
No
(2nd Person) First and Last Name
(2) Email Address
(3rd Person) First and Last Name
(3) Email Address
(4th person) First and Last Name
Email Address
*Note: Alternate persons in an exhibitor's table must register separately as an attendee.
Please choose categories of services your organization provides:
*
Advocacy
Employment Services
Education Services
Housing Services
Health and Treatment Services
Legal Services
Faith Based Organization
Family and Children
Other
Other
Does your client need to be on probation?
*
Yes
No
Does your client need to be on parole?
*
Yes
No
Age range of your target population (men and women):
*
Youth (ages 18-24)
Seniors (age 55+)
All ages
Special populations to qualify for support:
*
Program open to all populations
Women
Men
LGBTQQ
Foster Care
HIV+
Homeless
Disabled
Veterans
Those with mental health needs
Unemployed
Parents
Immigrants
Illiterate
Crime Survivors
Description of services or products you offer to formerly incarcerated individuals to support their post release needs:
(Maximum 75 characters)
Description of services or products you offer to crime survivors to support their healing:
(Maximum 75 characters)
I identified myself as:
*
A formerly incarcerated person
A family member with a loved one incarcerated
A crime survivor
None of the above
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