Academic Staff Leadership Conference 2008

Participation/Lodging Form

Please complete this form if you have registered for the Academic Staff Leadership Conference

Conference Attendee's Full Name:

Conference Attendee's E-mail Address:

Institution:

Position/Title:

Can we include you in the participation list?
Yes
No

Please indicate your preference for lodging at Southwest Hall.
Single Room
Shared Room
No lodging at Southwest Hall, please!

If you would like to share a room, please indicate the names of other
registered attendees with whom you would like to share a room:


Additional comments: