Participant Information
Name to appear on name badge

(include area code)
(include area code)
Please answer the following:
Select your gender:*
Have you previously been enrolled at HSU?* 
Have you completed a Bachelor's Degree or higher? *

Additional Participant Information

This sensitive information is submitted via SECURE SERVER, and is requested pursuant to Section 41201, Title 5, Calif. Code of Regulation and Section 6109 of the Internal Revenue Code.

Your date of birth is requested so that Humboldt State University may identify records that are unique to you.

Enter your date of birth:*                      

If you want to register for academic credit, you MUST provide the following:

HSU ID NUMBER or Social Security Number (000 - 00 - 0000):*   -     - 

Why do we ask for your Social Security Number? (opens new window)

SOCIAL JUSTICE SUMMIT REGISTRATION CATEGORY

Select one registration category. *
If you are registering for credit, also select an option under "Optional Academic Credit"

FREE $
FREE $
$25 $
$20 $
$25 $
FREE $
FREE $

FREE $
FREE $
OPTIONAL ACADEMIC CREDIT

Academic credit is optional. If you want academic credit, choose one of the courses that appear below.

NOTE: HSU students must WEB register by Jan. 29, and should not use this form.

Ethnic Studies: ES 480: 1 unit (21260)
$232 $
Women's Studies: WS 480: 1 unit (21082) $232 $
TOTAL REGISTRATION COST
$

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If you are still having difficulties, please call 707-826-3731 to register over the phone. (Monday-Friday, 8 a.m.-5 p.m.)

Please review the above information for accuracy before submitting this registration form.