Online Registration Form
Eastern North Philadelphia - May 17, 2008

Download Flyer

Time:  11 am
Location:  St. Bonifice, 2014 N. Mascher Street
 

*Name:
*Address:
*City: *State: *Zip Code:
Phone: (ex. XXX-XXX-XXXX)
E-mail:


Which community sector are you representing (check all that apply)?
Community resident - Youth
Community resident - Parent
Community resident - Concerned citizen (adult)
Community resident - Undergraduate or graduate student
Clergy
Elected Official
Local Business Owner/Representative
Media
Professional
School District of Philadelphia

Youth advocate

Other:

*Required Field