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Impact Leadership Retreat Registration
Please complete the following form to register for the 2020 Impact Leadership Retreat, which will be held September 11-13. Registration deadline is September 4, 2020.
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First Name
*
Your answer
Last Name
*
Your answer
Preferred Name
Your preferred name will be used for nametags and other retreat material.
Your answer
Preferred Pronouns
She/Her/Hers
He/Him/His
They/Them/Theirs
Other:
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Student ID Number
*
Your 700 Number
Your answer
Major
*
Your answer
Is this your first year at the University of Central Missouri?
*
Yes
No
Other:
Phone Number
*
Your answer
Email Address
*
We will be using email for all retreat communication, so please put an email address that you check regularly.
Your answer
T-shirt Size
*
S
M
L
XL
XXL
XXXL
Where will you be living in the fall?
*
Your answer
Will you be purchasing a meal plan for the fall?
*
Yes
No
Maybe
If you have any medical conditions or are taking any medications that we should be aware of, please explain here.
Your answer
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.
Your answer
Please tell us at least one thing you are hoping to gain by attending the Impact Retreat.
*
Your answer
Emergency Contact
*
Please include name, phone number and relationship.
Your answer
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