2013 Collegiate Leadership Conference registration
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The document is a registration form for a leadership event titled 'A Leader’s Legacy: Making History Every Day,' taking place on November 8 and 9, 2013. It includes sections for personal information, registration fees, and attendance options, particularly highlighting a track for first-generation college students. Participants can register either online or by mailing the completed form to Columbus State Community College, with details regarding accommodations and dietary needs provided.
![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](https://image.slidesharecdn.com/non-csccstudentregistrationform2013-131009101831-phpapp01/85/2013-Collegiate-Leadership-Conference-registration-1-320.jpg)
2013 Collegiate Leadership Conference registration
- 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