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Illinois AfterSchool Network Annual Conference
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Illinois AfterSchool Network Annual Conference
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IANconference@getvfairs.io
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First Name
Last Name
Email
Organization working for
Zip code of Organization
Program Type you work at
Please select
Community Based (non profit)
After and Before School (for profit)
School sponsored
Family Child Care Center
Faith Based
Park District
Library
Other
Other
Title/Position at your Organization
Do you receive CCAP funding
Please select
Yes
No
Are you a Teen Reach provider
Please select
Yes
No
How many youth do you directly impact? (Youth in the room on a daily basis)
Please select
25-50
50-75
75-100
100-150
150+
Not Applicable
How many youth do you indirectly impact? (in other programs at your organization)
Please select
50-75
75-100
100-150
150-200
200-250
250-300
300+
Not Applicable
How many families do you provide services to? (at your organization)
Please select
50-76
75-101
100-151
150-201
200-251
250-301
300+
Not Applicable
Care to share your demographic information with IAN for internal purposes only to help us understand who we serve?
Please select
African American
Asian
Caucasian
First Nation/Alaskan Native
Latinx
Muti-racial
Pacific Islander
Prefer not to share
Payment Method
Please select
Cheque in the mail (must be received in IAN office by March 4)
Credit Card using Stripe
Packages
Select Package
$150
Cheque Free Package
0.0
0.0
Payment Section
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Stripe connect (Stripe connect)
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