Registration Form

Vietnamese American Youth Leadership Conference

"Forming Leaders for the Vietnamese American Community"

VAYLC 2008 Sponsors: Freddie Mac, State Farm, Asian American Press; Media - Vietnamese American Television

Track Your Volunteer Hours & Be Recognized with a Volunteer Service Award

The National Congress of Vietnamese Americans is a certifying organization.

VAYLC Attendees (2004 and earlier) - Take online survey

Registration Form

Please complete this form to register for the Vietnamese American Youth Leadership Conference 2004.

Registration Fee (Registration is not complete until we have received your Conference fee):

Professional - $65
Student - $50
We accept Paypal - account: info(at)ncvaonline(dot)org

National Congress of Vietnamese Americans
c/o VAYLC
6433 Northanna Drive
Springfield, VA 22150

NOTE: Part of VAYLC will be held at Washington locations that have security protocols. Thus, we are requesting your Date of Birth and Social Security Number. This information will be shared with Federal Government Agencies only, i.e. White House and Pentagon. It will not be shared with anyone else.

Please provide the following contact information:

Title

First Name

Last Name

Middle Initial

Job Title

School/Organization/Company

Street Address

City

State/Province

Postal Code

Country

Phone

E-mail

URL

Age

Gender

Date of Birth

Social Security No.

Lodging/Hotel

Registration Type

How did you hear about this Conference?

Interested in exhibit space?

Are you currently involved in community service? If yes, please list them.

What are three (3) issues of concern in your community?

How would you like to change your community?

What do you hope to get out of this Conference?

Notes / Comments

VAYLC 2008 Sponsors