Summit Registration

Registration Forms & Lodging Information

Please fill out the appropriate form below. Please contact NCEJN Summit Coordinators ( for more information or clarifications.

Registration Form(s):

Links to the online 2016 Registration forms are available below. – Thank you for registering! If you do not receive a confirmation email from within 72 hours, please contact the EJ Summit Coordinators directly at or call Adrien at (214) 642-1056.

General Registration (lodging NOT included):

  • $120 for Friday
  • $120 for Saturday
  • $160 for both days

General Registration online form (click here for form)


Impacted Community Scholarship Registration — (lodging at Franklinton Center included) — FREE

Impacted Community Scholarship Registration form (click here for form)


Student Work Exchange Registration (dorm lodging including) — only offered to those students who cannot subsidize the general registration costs from other funding sources — $50 flat fee + volunteering at 2016 EJ Summit

Student Work Exchange registration Registration form (click here for form)


2016 Hardcopy Registration Forms are available here (.docx and .pdf). 
Please email to or mail to P.O. Box 68, Rocky Mount, NC 27802.


Registration Payment: You may use PayPal, Check, Money orders, or Pay on-site. Please make checks or money orders payable to: NCEJN Mail to: P.O. Box 68, Rocky Mount, NC 27802

Instructions for using PayPal to pay via credit card or PayPal account:

You may pay with your credit card through a PayPal link provided on NCEJN’s website. Go to On the right side of the page, there is a “Donate to NCEJN” button. Click on that. Enter the cost of your registration fee. If you do not have a PayPal account, but would like to use a credit card, below on the left side there is this option for using a credit card. Click on that. This will allow you to enter in your credit card information. In the notes box, please mention that this is for your registration fee for the 2016 EJ Summit (e.g. Friday only 2016 Summit or donation for 2016 Summit). Once your payment is submitted, it goes directly to our NCEJN PayPal account.


Lodging at the Franlinton Center is currently at capacity. Please email us at if you no longer need your spot as others are still on the waiting list for Franklinton Center lodging. 

Lodging at the Franklinton Center will be reserved for those requesting the Impacted Community Scholarship and the Student Work Exchange until September 30, then available rooms will be opened up to General Registrants (i.e. lodging for scholarships is not guaranteed after September 30). All Franklinton Center rooms will have at least 2 people per room. All registrants that have requested lodging at the Franklinton Center must notify the Coordinators by October 10 if lodging is no longer needed; otherwise, we will ask you to pay $25 for the dorm room and $40 for the hotel-style room.

Those that are General Registrants and would prefer to stay at the Franklinton Center will be put on a waiting list. On October 1, any available rooms on-site will be assigned to the General Registrants on the waiting list. Dorms will cost $25 per person and hotel-style rooms will cost $40 per person. People that do not want to stay on-site or that need to have lodging secured prior to October can reserve a room at the Country Inn & Suites for $79.00 per night for Friday night under the reservation name NCEJN.

Additional Off-site Lodging information for General Registrants: The Country Inn & Suites has reserved 5 rooms with two queen beds and 3 rooms with one king bed for EJ Summit attendees. You are responsible for contacting the hotel directly to book your rooms and to make it known if you are willing to share the double queen room with another EJ Summit attendee. The King rooms also have a roll out bed for an additional $10.00 if you would like that option. When you call the Country Inn & Suites, make sure to say you would like to book one of the rooms reserved for NCEJN.

The room rates are $79.00 per night for Friday night only under the reservation name NCEJN. The deadline cutoff date to reserve a room is October 7th. Because there is a big baseball tournament being held in Rocky Mount the same weekend as the EJ Summit, all hotels are being booked solid. The NCEJN reserved rooms at the Country Inn & Suites will be released by the end of October 7. Any reservation cancellations will have to be made by October 12th.

Country Inn & Suites By Carlson, Rocky Mount, NC
672 English Road, Rocky Mount, North Carolina, 27804, US
p: +1 (252) 442-0500  f: +1 (252) 442-0964

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