2020 Leadership Academy Online Attendee Form

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Greetings! We are excited to have you be part of the Virtual 2020 Leadership Academy and are looking forward to another outstanding year of developing learning, leadership, and service!

The purpose of this survey is two-fold: (1) it completes your registration for the upcoming 2020 Leadership Academy; and (2) to gather information for internal research purposes.

All personal identifying information will be kept confidential.

We appreciate you taking the time to provide us this information. It will help to us to continue to provide relevant and purposeful programs in the future.

This form must be completed in ONE SITTING -- you will not be able to save your work. Plan for at least 15 minutes to complete all fields.

First Name *

Preferred Name

If the same as the first name you entered above, please leave blank.

Last Name *

Home Mailing Address (include CITY & ZIP CODE) *

Best Email Address *

For correspondence about Leadership Academy logistics. **we are NOT able to send to student district email addresses**

Cell Phone Number *

We will only use this number for Leadership Academy and emergency purposes.

School (attending in FALL 2020) *

T-shirt Size *

Leadership Academy t-shirts are standard adult shirts.

Please list any allergies, reactions to medicine, or unusual physical conditions that should be made known to a treating physician *

Are you a *

Student

Advisor

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