REGISTER: CEJC Central Valley Regional Conference in Fresno – April 1st 2017 – California Environmental Justice Coalition

REGISTER: CEJC Central Valley Regional Conference

April 1st 2017

9am – 5pm

Community United Church of Christ

5550 N. Fresno St.

Fresno

Name/Nombre(required)

Organization/Organización

City/Area of Work- Ciudad/Area de Trabajo(required)

Email Address/Correo Electrónico(required)

Phone Number/Numero de Teléfono

Do you need assistance with transportation?/¿Necesita asistencia con transportación?(required)

Yes No

If Yes> What kind of assistance? Where are you traveling from?/¿Si necesita asistencia, indique de cual, de donde viaja?

Can you provide transportation for others?/¿Puede transportar a otros?(required)

Yes No

If Yes> How many people can you provide a ride to? Where are you traveling from?/¿Si puede transportar a otros, cuantos, y de donde viaja?

Do you have any dietary restrictions or requests? (Vegan, food allergies, etc.)/¿Tiene restricciones alimenticias o tiene preferencias? (Por ejemplo, vegetariano o alergias)(required)

Yes No

If Yes> What are they?/Explique.

Do you have child care needs?/¿Necesita cuidado de ninos?(required)

Yes No

If Yes> How many children will be attending with you? What are their ages?/¿Si necesita cuidado de ninos, para cuantos y de que edad?

Please briefly describe what regional Environmental Justice issues you are concerned with and would like to see discussed at this conference, as well as what goals and outcomes you would like to see reached./ Brevemente esplique las preocupaciones de su region al respecto de la Justicia del Ambiente que le gustaria que discutiéramos en la conferencia. Que resultados o metas le gustaria que tuvieramos en esta conferencia.

Please provide any other relevant information or assistance you may need to attend and participate in this conference/ Por favor explique otras necesidades o precupaciones que tenga sobre las posibiladades para asistir y participar en esta conferencia.

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