"Best in Class" Student Engagement Conference -- October 21-22, 2011

Registration Deadline - September 30, 2011

---------------------------------------------Section I: Registrant Information----------------------------------------------

*First Name:

*Last Name:

*Institution

*Position/Title

*Email:

*Address Line 1:

Address Line 2:

Address Line 3

*City:

*State:

*Zip Code:

*Phone Number:

*Email Address:

-------------------------------------------Section II: Registration Information-------------------------------------------

Please note that the Student Leadership Institutes in this conference are designed to build on one another, so attendance to all sessions is required.

*Choose a Registration Type

*Gender

Dietary Needs

If Other selected above, please describe:

Other Special Needs:

-------------------------------------------Section III: Payment Information-------------------------------------------

We do not have the ability to accept credit cards or electronic payments.

Please follow the instructions below to complete your registration and submit payment by September 30, 2011.

Please send payment AND a copy of registration form (print this page) to:
Michele Lowrey
Pennsylvania Campus Compact
PO Box 4508, One College Avenue
Grantham, PA 17027

All checks must be received by October 4, 2011. All checks should be made payable to Pennsylvania Campus Compact.

Questions regarding payment can be directed to Michele Lowrey at mlowrey@paccompact.org or 717-796-5072, Ext. 1.

Acknowledgements

Pennsylvania Campus Compact would like to thank the Jenzabar Foundation for their support of this event.

Final Confirmation

Prior to hitting the submit button below, please print this page for your records and include with your payment. 
 
Your registration is NOT complete until you hit the submit button.

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