Tuesday, June 21, 2016

REGISTRATION FORM:2016 Theme: “Black Lives Matter” Saturday, September 10, 2016

14th Annual Congress of African Peoples’ Convening

2016 Theme: “Black Lives Matter”

Saturday, September 10, 2016


Please register and return your completed form by 9/5/2016    
(print and mail with payment to address below )   


Mailing Address________________________________________________________

City, State, Zip ________________________________________________________

Email address
(Please print clearly) ________________________________________________________

Phone number, including area code____________________________________

Fax number, including area code_______________________________________

Website _______________________________________________________________

Dietary Needs:
___ Vegetarian
___ Vegan
___ Other, Please explain _______________________________________________

Registration Fee: (Check One)
Individual                                                                      ___$20.00
Seniors/Students & individuals w/limited funds       ___ $ 5.00 
Local non-profit organizations                                      ___ $25.00
Local large non-profit & National                                  ___ $50.00

 Amount included:
Form of payment: (Please circle)          Check              Cash                Other

Please make checks payable to Black United Fund/CAP and mail to: 
Black United Fund: 4104 44thStreet Sacramento, CA 95820. Attn: CAP.
Register online at: https://www.eventbrite.com/e/black-lives-matter-tickets-26045198891 
(916) 484-5025

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