2016 Indiana Delegates to National Convention Registration Form

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If you have already registered for the NJCL National Convention, please continue.

If you have not registered, please read through the materials at http://www.njcl.org/pages/convention-registration, complete your registration, and then come back here to complete this form.

Remember that you are supposed to request and pay for the pre-convention housing option when you register.

In addition to the national fees, you will also need to pay $30.00 to the Indiana JCL to pay for your state supplies. After completing this form, you will receive a form via email with payment addresses and other important things to remember.

Costs involved:

$495--NJCL Convention Registration--paid to NJCL at time of registration
$55--NJCL Convention Pre-Housing Option--paid to NJCL at time of registration (includes housing and two meals)
$30--IJCL State Delegate Fees--paid to IJCL after registering (includes picnic, two state shirts, state spirit, pre-convention meal)

If you have questions, please don't hesitate to email chair@ijcl.org to ask.

First name *

Last name *

Age *

Gender *

Date of Birth *

You can type the date in if you don't want to use the calendar button.

YYYY

Street Address *

City *

State *

Please use the two letter format.

Zip Code *

Participant Email Address *

Parent Email Address (if a student)

Participant Cell Phone Number *

Use this format: xxx-xxx-xxxx

Parent Cell Phone Number

For students only. Please use this format: xxx-xxx-xxxx

Home Phone Number *

Use this format: xxx-xxx-xxxx

T-Shirt Size *

You will receive two state t-shirts as part of your convention experience.

Please list any allergies or dietary requirements. *

If you do not have any allergies or dietary requirements, type "none".

Chapter *

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