*Fields required

Your Information

First Name *

Last Name *

Name as you would like it to appear on name badge *

Email *

Cell Phone * (xxx-xxx-xxxx)

Address *

City *

State (scroll for selection) *

Zip *

Gender (scroll for selection)

Emergency Contact Person *

Emergency Phone * (xxx-xxx-xxxx)

Ministry Information

Your Ministry/Community Affiliation * (scroll and select one)

If student, scroll and select one *

If adult, scroll and select one *

Event Information

Scroll and select one *

Rooming (check all that apply) *

I will need a room on the following event nights:

All event nightsNo event nightsOne extra night-early arrivalOne extra night-late departure

Meals (scroll and select one) *

Meals I will not need (i.e. Last day box lunch) (If none, enter "NA") *

Special dietary needs (If none, enter "NA") *

Flight information

Air arrival (date/airline/flight number/time)

Air departure (date/airline/flight number/time)

Any other special needs or information (If none, enter “NA”) *

FOR LSJI: ADULT EL OTRO LADO PARTICIPANTS ONLY

1. If, for Ministry/Community Affiliation above, you indicated Other, provide Ministry information here.

Name of Ministry or Community

Ministry City

Ministry State (scroll for selection)

Ministry Country

Note: Under the Rooming options above, (1) the No Events Nights option is available only to El Paso residents, and (2) the two extra nights options are not available for this event.

2. Type of international travel document (required for all participants):

U.S. Passport (required for U.S. citizens to attend)VisaOther

If other:

Document Expiration Date

Date of birth (mm-dd-yyyy)

3. Christian Brothers Conference Travel Policy (Check box to acknowledge.):

I understand that all travel arrangements and costs, including air fare, train, bus and/or other ground transportation costs to and from LSJI, are the sole responsibility of the participant.

4. Christian Brothers Conference Events Photography/Video Policy (Check box to acknowledge.):

By attending this event and its activities, participants understand that their image may be captured by Christian Brothers Conference or the District of San Francisco New Orleans and may be used without compensation in photographs, videotapes, motion pictures or any other recordings or other record of this event that contains that image for any purpose, including for future advertising for the event.

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