Registration Form

National Leadership Conference on Student Government Registration Form

 

Institution Information:

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Attendee Information:

 
Please provide accurate name for each attendee so nametags can be created correctly. If names are unknown at this time, please indicate attendee's title/position, in each name box, to assure conference participation.
 
Attendee 1:
 
 
 
 
Attendee 2:
 
 
 
 
Attendee 3:
 
 
 
 
Attendee 4:
 
 
 
 
Attendee 5:
 
 
 
 
Attendee 6:
 
 
 
 
Attendee 7:
 
 
 
 

Summary Information:

 
Check or purchase orders for total amount must be mailed with your school's name in the subject line. Make checks or purchase orders payable to Center for Leadership Development, Inc.
 
Mail checks to: Center for Leadership Development, Inc. Conference Registration Office 2100 Hillview Dr. Manhattan, KS 66502
 

 
Please complete the image verification below before clicking the submit button on this form. This is a precaution against spam being submitted to the form e-mail link.
 
  
 
 
Partial refunds will be honored before October 1, 2012.
 
No refunds after October 1, 2012.