Registration Form

  • Please use a separate registration form for each person.
  • Please indicate which payment options you will be making.

First Name:
Last Name:
 
Address:
City:
State:
Zip/Postal Code:
Country:
Home or Cell Phone:
E-mail:
 
In case of emergency please notify
Name:
Relationship:
Phone:
 
University/College Affiliation:
If your college was not on the list, please type it in here:
If your go to UCSD, please put your student ID here:
 
Organizational Affiliation
Are you over 18 years of age?
Year in College/University?
Is this your first Excel Leadership Conference?
How did you hear about the 16th Annual Excel Leadership Conference?
If you choose "Other", please specify:
 
If an Organization is paying for you, which Organization?
Payment Information:
  • ALL PAYMENTS MUST BE MADE BY CHECK.
  • ALL CHECKS, MADE PAYABLE (IN US FUNDS ONLY) TO: UCSD EXCEL
  • ALL CHECKS MUST BE POSTMARKED BY FEBURARY 10, 2007
  • ALL CHECKS, MAILED TO:
       University of California, San Diego
       Student Organizations & Leadership Opportunities Center (SOLO)
       c/o Marilyn Russell
       9500 Gilman Drive
       La Jolla, CA 92093-0078
Regular
Submit online form & postmarked check by 2/10/07
Late & Day of
Submit online form & postmarked check after 2/10/07
UCSD
Students
$0,
Donations Accepted*
$0,
Donations Accepted*
Non UCSD
Students/Staff/Faculty
$10.00 $15.00
* All donations benefitting Friends of Scott
*** Day of registration attendees are welcome!


CONFERENCE REFUND POLICY

Full Refund Until Feburary 10, 2007
No Refunds After Feburary 11, 2007
All refunds must be submitted in writing to marilynr@ucsd.edu

**We will not take refund requests over the phone or via e-mail. Please submit written request by the postmark dates listed above.