A Leader’s Legacy:
Making history every day
November 8 & 9, 2013
Non-Columbus State Student Registration Form
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2013 Collegiate Leadership Conference registration

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Registration form for non-Columbus State students to attend the November 8-9, 2013 Collegiate Leadership Conference of Ohio.

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2013 Collegiate Leadership Conference registration

  1. 1. A Leader’s Legacy: Making history every day November 8 & 9, 2013 Non-Columbus State Student Registration Form Name (Print clearly) ____________________________________________________________ Email Address ________________________________________________________________ Street Address ________________________________________________________________ City ___________________________________ State ___________ Zip Code ___________ Telephone ____________________________________________________________________ College or University ___________________________________________________________ T-Shirt Size: S M LG XL XXL *Are you a First Generation College Student? There is a special track just for you! Please check the box below if you and/or your family will arrive early at 3 p.m. Following the reception, your family will be invited to attend a free workshop. Please visit our website for more information. [ ] I am a first generation college student (I’m the first in my family to attend college) [ ] I will attend the reception. [ ] My family will attend (#______members) the reception. Registration Fees postmarked by October 15, 2013: [ ] General Registration for Non-Columbus State Community College Students, $30 [ ] Group Registration (ten or more), postmarked by October 15, 2013, Number Registered:______ ($30 a person and get the tenth student free) [ ] Late Registration (postmarked by October 25, 2013) $40 Check this box if you need a vegetarian boxed lunch option [ ] Quantity: _____ If you have special needs or require assistance please contact us before the conference so that we can accommodate you. Please Mail Registration Form to: Columbus State Community College Student Engagement and Leadership, Nestor Hall 116 ATTN: Kimberly Rhyan 550 East Spring Street / Columbus, OH 43215 Phone: (614)287-3621 Fax: (614)287-3683 Make Checks Payable to: Columbus State Community College

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