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:
   
E-mail:
   
Emergency contact
Name:
Relationship:
Phone:
   
Organizations you are involved with (please include your position within your orgainization):
 
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.
   
Please enter the text as it appears below. Hit the refresh button refresh buttonto get another text challenge if you are having problem viewing the current text.