| Fall Leadership Summit Registration |
| Contact Information |
| First name |
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| Last name |
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| How would you like your name to appear on your nametag, if different than above? |
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| Phone Number |
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| Email |
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| Graduation Year |
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| Local address (campus mailbox or off-campus address) |
Street
Campus Box
City
State
Zip |
| List student organization affiliation, if any |
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| Gender identity (optional) |
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| Have you taken StrengthsQuest? |
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| If Yes, what are your five strengths? |
1.
2.
3.
4.
5.
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| What do you hope to learn by attending the Leadership Summit? |
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| Please list any allergies or special needs (dietary, etc) |
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| Leadership Summit Security Deposit |
| To secure your space in the Leadership Summit, a $25 deposit is required. If you attend the program, your student account will not be affected. By clicking yes here, you agree to attend the Leadership Summit on Friday, October 16 - Saturday, October 17, 2009, and understand that if you do not attend the event and have not cancelled your registration by 12:00pm on Friday, October 9 your student account will be billed $25.00. The security deposit is 100% refundable if you cancel your registration by 12:00pm on Friday, October 9. |
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Yes, I agree to the above terms |
Please take a moment to look over your information before pressing the Submit button below.
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