Student Leadership Summit Form

Becoming Tomorrows Leaders
Feb. 20, 2010

 

To Register You Must:

  • Be an active ENMU Student
  • Have a 2.5 GPA

Personal Information
First name:
Last name:
Middle initial:
   
ENMU ID number:
   
Address:
City:
State:
Zip Code:
   
Home phone:
Other phone:
   
Email:
   
Emergency contact
Name:
Relationship:
Phone:
   
Organizations you are involved with (please include your position within your organization):
 
Are you registered with the Student Leadership Certificate Program?
 



Prior leadership experience:
 
   
Special requests:
Dietary:
Sign interpreter:
TDD (Telecommunication Device for the Deaf):
Wheelchair access:
Other:
   
Policies/Disclaimer
By checking this box, I agree that I will behave in a mature and professional manner at all times during the conference. I understand that if I use inappropriate language, demonstrate inappropriate behavior, or behave in a disruptive manner I will be asked to leave. I certify that all of the above information is correct.
   
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