Event Registration

Presenter Registration Middle Level Student Leadership Conference

This is a wonderful opportunity to share your leadership experiences and ideas with middle-level student leaders from the diverse groups in Connecticut and to have a potential impact on how they will work with others as the develop as thinking leaders. There will be four breakout sessions beginning at 9:15 a.m. and ending at 1:40 p.m. Each session runs for 50 minutes, and you will be scheduled for a minimum of one and a maximum of three sessions. (Lunch will be included for you)
  • Date: January 4, 2019 and January 16, 2019
  • Time: 9:00 a.m. to 1:45 p.m.
  • Site: January 4, 2019 at Sacred Heart University, Fairfield; January 16, 2019 at Trinity College in Hartford
  • Registration Deadline: November 26, 2018
  • Cost: No Charge


Note: Items with * are required.
Registrant Name*: First*:
Last*:
Affiliation*:
Phone*:
Fax:
E-Mail*:
Re-Enter E-Mail*:
Mailing Address*:
City, State and Zip*:
Location Presenting At*
Topic of Presentation*
Title of Presentation*
Will you be bringing students to present with you? *
If you are bringing student presenters, please provide their names
Cell Phone Number (In the event we need to reach you on the day of the event)*