Summer Leadership Institute

 

First Name: 
Last Name: 
Name Preferred for Badge: 
E-mail: 
IU Campus: 
Address: 
Daytime Phone: 
(include area code)
Night Phone: 
(include area code)
 

 

MEALS
I WILL attend the following meals:

Lunch-Friday, May 19th (served @ TriState University)


I prefer vegetarian meals  Yes  No

Other dietary or special needs:


EMERGENCY CONTACT In case of emergency, please contact: 

Name:  Phone:  Relationship: 

 

If you get a white page with an error message after you click "submit" please contact the FACET office (317-274-5647) - your registration has not been processed.