Power in Diversity Conference Registration

Power in Diversity Conference 2019 LeadMN Application

January 24-26, 2019.

Applicant Details

First Name

Last Name

Gender

Phone Number

Are you 18 years of age or older? The Power and Diversity conference requires that all attendees be 18 and older.

YesNo

Campus Name

Position within LeadMN

Position on Campus

If you selected "Other," please list the position below:

The Power in Diversity Conference is located at St. Cloud State University. LeadMN covers the registration fee and hotel fee for students selected to attend. We are unable to provide transportation or reimburse mileage. I understand that if selected I am responsible for securing my own transportation to and from the conference.

YesNo

Please describe why you woud like to attend the "Power in Diversity Leadership Conference"?

Please describe how you plan to use the information you learn from the Power in Diversity Leadership Conference on your campus or in your community?

If selected to attend the Power in Diversity Conference I agree to abide by LeadMN's Code of Conduct.

Yes, I, the applicant, have read and agree to the above statement and LeadMN Code of Conduct.

By submitting this application and checking the box below, the applicant acknowledges that they are, to the best of their knowledge, at the time of the application, able and willing to fully participate in and for the duration of the Power and Diversity Leadership Conference as well as a follow-up conference debrief, to be scheduled at a later date. After being selected, the applicant will receive a confirmation email also requesting confirmation of their attendance. Upon confirmation, should the applicant be chosen and unable to attend, the applicant agrees to inform LeadMN staff via email by Thursday, January 4, 2019. Should the selected applicant fail to inform staff within that time period, the selected applicant may be responsible for finding another student to replace them in their absence or be subject to pay for the conference costs.

Yes, I, the applicant, have read and agree to the above statement.

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Power in Diversity Conference Application

Power in Diversity Conference 2019 LeadMN Application