Summit VI Registration — UCLM

Registration Form for UCLM's Summit VI

Straight Talk:Violence or Non-Violence? You Choose.

Name

First Name

Last Name

Organization & Role (if applicable)

Email Address

Phone number

Street Address, City, State, Zip Code

Please check which day or days you will attend.

Both days - Thur 6/15 & Fri 6/16

Day 1 - Thursday, 6/15

Day 2 - Friday, 6/16

Type of Attendee - please check all that apply

Law Enforcement

Clergy

Press

Community Member

Other

Please specify what you mean by other

WE ARE GRATEFUL FOR THE GENEROUS SUPPORT FROM:

Jeannie & David Gloss