Student Leadership Summit Form

Resume Writing and Interviewing Skills
October 24, 2009

To Register You Must:

Personal Information
First name:
Last name:
Middle initial:

ENMU ID number:

Address:
City:
State:
Zip Code:

Home phone:
Other phone:

E-mail:

Emergency contact
Name:
Relationship:
Phone:

Organizations you are involved with (please include your position within your orgainization):

Are you registered with the Student Leadership Certificate Program?
	Yes No
Prior leadership experience:


Special requests:
Dietary:
Sign interpreter:
TDD (Telecommunication Device for the Deaf):
Wheelchair access:
Other:

Policies/Disclaimer
By checking this box, I agree that I will behave in a mature and professional manner at all times during the conference. I understand that if I use inappropriate language, demonstrate inappropriate behavior, or behave in a disruptive manner I will be asked to leave. I certify that all of the above information is correct.

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