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: *

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: *

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

Advocacy	Employment Services	Education Services
Housing Services	Health and Treatment Services	Legal Services
Faith Based Organization	Family and Children	Other Other