Please provide the following registration information below:
Required:
*First Name:  
*Last Name:  
Company/School Name:  
*E-mail:  
*Phone Number:  
Optional:
Note: This information will be shared with guest participants after the event.
Twitter Account:
Facebook Account:
Linked-in Account:
Secondary Email Account:
Secondary Phone Number:

Note: Upon completing this form and clicking on the Register Now button (below), you will be taken to PayPal where you will be asked to make your $25/person payment.  

Thank you again for your support of the Center for Hispanic Leadership - and we look forward to providing you an exciting “Golden Ticket” experience you will never forget!