Conference Registration
In-Person or Virtual

- Child & Youth Protection

Registration and Reservation

DEADLINE March 31, 2021
***Please note: If you prefer to pay for your registration via a physical check, please select 'Pay Later' after completing the form and mail your check made payable to Roman Catholic Diocese of Tulsa to:

Roman Catholic Diocese of Tulsa
C/O Donna Eurich
PO Box 690240
Tulsa, OK 74169-0240
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- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- (Arch)Diocese REQUIRED Please fill out this field. Please enter valid data.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Work Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Mobile Phone Number Please enter a phone number.
- Work Address REQUIRED Please fill out this field. Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Role REQUIRED Please fill out this field.
- Will you attend the Orientation Workshop for New Safe Environment Coordinators and Victim Assistance Coordinators on June 20, 2021, 12:00 P.M- 4:00 P.M. REQUIRED Please fill out this field.
- Will you attend the Tuesday Evening Reception and Dinner REQUIRED Please fill out this field.
- List any dietary restrictions:
- Ticket Options REQUIRED
  400.0 – In-Person Attendance
  200.0 – Virtual Attendance Please fill out this field.
- Indicate if a guest will attend the Tuesday Evening Reception and Dinner ($50 per guest)
  50.0 – +1 Guest
  100.0 – +2 Guests
  150.0 – +3 Guests
  200.0 – +4 Guests
- COVID-19 RELEASE & WAIVER
  
  I certify that I have read the above Release in its entirety, that this is a legally binding waiver and release of liability, and that I am at least eighteen (18) years of age. I sign this Release voluntarily and of my own free will. I understand that this Release is mandatory for the participation in the CYPCLC.
- Acknowledgement of Covid-19 Waiver & Release REQUIRED I Agree Please fill out this field.
Total:

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Pay Now

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Conference Registration In-Person or Virtual

COVID-19 RELEASE & WAIVER

Conference Registration
In-Person or Virtual