2012 Leadership for Social Justice Institute

2012 Leadership for Social Justice Institute Registration-July 30-August 3, 2012.

Please complete this registration for the 2012 Leadership for Social Justice Institute. Please note that there are additional meeting dates (June 12, 4:00-7:00pm and August 9, 10:00am-3:00pm). These can be done either face-to-face or online.

If you are taking the Institute for credit you will be asked to complete additional paperwork. If you have any questions, please contact Lisa Hebgen at lmhebgen@wisc.edu or 608.574.0355.

Question Title

* 1. Please provide your contact information.

Full Name:

Position:

School:

Distict/Organization:

Email Address:

Question Title

* 2. Are you planning on taking the Institute for credit?

Yes (3 credits for $1,211.13 for special students & graduate student regular rates apply)

No; $450.00 for individual; $435 for teams of 2-7; $420 for teams of 8 or more (non-credit team discounts will be reflected on invoice).

Question Title

* 3. Do you have any dietary or special accommodations?

Yes, please describe below

Other (please specify)