Texas Leadership Round-Up Regisration Form at Campus Harmony Inc.

Conference Registration Form

Campus Harmony, Inc’s Lonestar Leadership Institute
October 29 – November 1, 2009 • Crowne Plaza Hotel • Arlington, TX
Please print or type—complete a separate form for each participant!

Click here to print and mail the form. You can also fax the form to (214) 635-1987.(Note: You must have Adobe PDF to use this feature).

Name:

Title:

College or University:

Home Address:

City:

State:

Zip Code:

Daytime Phone No:

Fax No:

E-mail Address

I Identify as:

Male
Female
Transgender
Other
Prefer not to answer

Are you interested in attending the opening night icebreaker and t-shirt swap?

Yes
No

Are you interested in attending the Friday night Round-up dance?

Yes
No

Which of the following would you like to participate in on Saturday after 3pm?

Tour of the Dallas Cowboys Stadium
Ttour of the Ballpark in Arlington (home of the Texas Rangers)
Ripley's Believe It or Not
Six Flags

Which track BEST fits your leadership training needs?

Student Leadership Certification: Improving your leadership skills
Student Mediation Certification: Peacefully resolving conflict in your organization
College to Corporate Transition

Please list your current school activities, positions held, or leadership experiences. (Limit to 100 words or less):

Do you have any accessibility needs relating to your participation in this conference? (If you indicate yes, please contact John Welch at 214-635-1985 to discuss your needs).

Yes
No

If applicable, indicate meal requirement.

Vegan
Vegetarian
Kosher
Diabetic

Please indicate any medically necessary diet needs.

Conference Registration Form *Campus Harmony, Inc’s Lonestar Leadership Institute* October 29 – November 1, 2009 • Crowne Plaza Hotel • Arlington, TX Please print or type—complete a separate form for each participant! Click here to print and mail the form. You can also fax the form to (214) 635-1987.(Note: You must have Adobe PDF to use this feature).
Name:
Title:
College or University:
Home Address:
City:
State:
Zip Code:
Daytime Phone No:
Fax No:
E-mail Address
I Identify as:	Male Female Transgender Other Prefer not to answer
Are you interested in attending the opening night icebreaker and t-shirt swap?	Yes No
Are you interested in attending the Friday night Round-up dance?	Yes No
Which of the following would you like to participate in on Saturday after 3pm?	Tour of the Dallas Cowboys Stadium Ttour of the Ballpark in Arlington (home of the Texas Rangers) Ripley's Believe It or Not Six Flags
Which track BEST fits your leadership training needs?	Student Leadership Certification: Improving your leadership skills Student Mediation Certification: Peacefully resolving conflict in your organization College to Corporate Transition
Please list your current school activities, positions held, or leadership experiences. (Limit to 100 words or less):
Do you have any accessibility needs relating to your participation in this conference? (If you indicate yes, please contact John Welch at 214-635-1985 to discuss your needs).	Yes No
If applicable, indicate meal requirement.	Vegan Vegetarian Kosher Diabetic
Please indicate any medically necessary diet needs.

Conference Registration Form

Campus Harmony, Inc’s Lonestar Leadership Institute October 29 – November 1, 2009 • Crowne Plaza Hotel • Arlington, TX Please print or type—complete a separate form for each participant!

Campus Harmony, Inc’s Lonestar Leadership Institute
October 29 – November 1, 2009 • Crowne Plaza Hotel • Arlington, TX
Please print or type—complete a separate form for each participant!