Ventura County Women's Forum: EDUCATIONAL JUSTICE

EDUCATIONAL JUSTICE

Saturday
April 12, 2008
8:30 am to 3:30 pm

CSUCI (map), Malibu Hall
20 Chapel Drive
Camarillo, CA 93012

Click to Register Online	Click for Printable Registration Form
Deadline for your org. to be included in booklet of services: March 12, 2008 Registration limited to the first 150 paid registrants

ONLINE REGISTRATION

Registration will be limited to the first 150 paid registrants. Applications will be processed in the order they are received and paid in full. If capacity has been reached prior to processing your application, you will be contacted within a week and your registration fee will be returned.

Name

Organization	Position
Address	City/State/Zip
E-mail	Home Phone

Additional Registrants:

Special Needs:
Vegetarian Meal
ADA Accommodations (please specify)

If you represent a service organization, please complete the following information about the organization. Information must be provided by March 12, 2008 to be included in the booklet of services that will be distributed at the Forum.

Organization was included in the Booklet in 2006, and the information has not changed.

Name of Organization

Phone

Email

Website

Brief Mission Statement (75 words or less)

Check which services your organization provides:

Campaign Assistance

Hospice

Scholarships

Childcare Assistance

Housing Assistance

Scholarship Counseling

Counseling

Immigration Assistance

Senior Services

Domestic Violence/Abuse

Job Placement

Tax Assistance

Family Services

Job Training

Teen Services

Financial Assistance

Labor Representation

Transportation Assistance

Financial Planning

Leadership Training

Tutoring

Grants for Individuals

Legal Assistance

Volunteering

Grants for Organizations

Legislative Assistance

Other:

Health Care

Mentoring

Health Education

Parent Education

Does your organization offer scholarships or grants? Yes No

If yes, please fill in the following information:

Eligibility Requirements

Contact Name

Phone

Registration Fee: $60 per person ($20 per student with ID).

Check your method of payment:
I will mail a check separately to VCCW, 4360 E. Main Street #460, Ventura, CA 93003. Make checks to: VCCF/VCCW Fund, Tax ID #77-0165029
Amount

I will submit an on-line payment using a link to paypal on the next page. (You do not need to have or open an account with paypal to pay with a credit card.)
Amount

Amount intended for Registration, $60 per person ($20 per student with ID):
Amount intended as tax-deductible donation to VC Women's Forum:
Amount intended as tax-deductible donation to VC Commission for Women:

The first 150 paid registrants will receive a copy of the book, Letters to a Serious Education President (Seymour Sarason, 2006), courtesy of SAGE.

For additional information: (805) 658-4193 or visit http://www.vcwf.org.

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