A Walk in Their Words Registration

Who are you registering?

First Name ^*

Last Name

Email Address ^*

Confirm Email Address

Date of Birth

Phone Number (No spaces or dashes)

Check this box if you agree to receive text messages. Your number will only be used to share information about A Walk In Their Words

Street Address

City

State

Zip Code

Check this box if you are registering someone under the age of 18.

By checking this box I I hereby release the MOHAWK VALLEY RESOURCE CENTER FOR REFUGEES (The Center), and Mohawk Valley Community College from any liabilities that may occur at this event.