Student Leader Networking Reception- Fall 2012 Registration

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Please register to attend the Student Networking Reception. This is an opportunity to directly connect with other student leaders from across campus and explore new ways to collaborate. All students are invited to attend even if they are not affiliated with a student organization, living center, or campus department.

Please join us on Monday, November 12, 2012 at 7:30 pm in the Grand River Room in the Kirkof Center.

If you have any questions about this event, please email or call the Office of Student Life at 616-331-2345.

* 1. First Name

* 2. Last Name

* 3. What is your G number?

* 4. Please indicate your preferred email address.

* 5. Please select one:

* 6. Do you live on campus?

* 7. Please indicate your TOP 3 areas of involvement in student organizations, living centers, campus departments, etc AND your position (Example: Kistler Living Center Resident Assistant, Student Senate VP of Finance, Women's Center Ambassador, Black Student Union- member, etc. (Please enter N/A in areas that do not apply.)

* 8. We would like to provide our attendees with a list of contact information in order to do so we would use the information provide to us in questions 1-4. Please indicate Yes if you would to be included on the list or No if you would not like to be included.

* 9. Please share a unique or interesting fact about yourself. This information will be used for a networking activity that will take place during the reception, so please share only something that you would want the attendees of this program to know about you.

* 10. How did you hear about the Student Leader Networking Reception? (Please check all that apply):

* 11. Have you attended a Laker Leadership Program before? (

* 12. Do you live on campus?

* 13. Photo policy: Photos may be taken during this event for promotional purposes (such as web site, mailings, etc) by the Office of Student Life. If I do not want my photo taken, It understand that it is my responbility to inform the event coordinators when I arrive at the event.