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2013 Leadership Conference Registration Form

"Educate, Empower & Execute"

Saturday, March 2
9 a.m. - 2 p.m.
Olin B. Sansbury Jr., Campus Life Center
USC Upstate

Registration deadline: Thursday, February 21, 2013.

Please Submit the Following Information

 An asterik (*) indicates that a response is required.

Full Name:  *

Email:  *

I am a (select all that apply):*

If a high school student, what is the name of your school?:

If you are a member of an organization that is helping with the 2013 WLN Conference, please list those organizations here:

Please indicate the types of sessions you would be interested in attending (select up to four):*

Please indicate any food allergies or dietary restrictions (please write "none" if you have no restrictions:  *

Please indicate any needs/considerations that you'd like to make us aware of:

How did you hear about the 2013 WLN Conference? (i.e., USC Upstate website, current student, faculty/staff member, local publication, etc.):