Impact Leadership Retreat Registration
Please complete the following form to register for the 2022 Impact Leadership Retreat, which will be held September 9-11. Registration deadline is September 2, 2022.
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First Name *
Last Name *
Preferred Name
Your preferred name will be used for nametags and other retreat material.
Preferred Pronouns
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Student ID Number *
Your 700 Number
Major *
Is this your first year at the University of Central Missouri? *
Phone Number *
Email Address *
We will be using email for all retreat communication, so please put an email address that you check regularly.
T-shirt Size *
Where will you be living in the fall? *
Will you be purchasing a meal plan for the fall? *
If you have any medical conditions or are taking any medications that we should be aware of, please explain here.
If you have any special dietary needs (vegetarian, allergies, etc.) please explain here
A couple of meals will be provided and this information will help us accommodate your needs.
Please tell us at least one thing you are hoping to gain by attending the Impact Retreat. *
Emergency Contact *
Please include name, phone number and relationship.
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