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Midwest Leadership School Registration Form   (page 2 of 2)

I understand the importance of my full commitment in the formation of this intentional community. In registering, I agree to stay the entire week and to participate in all scheduled classes and gatherings.

Participant for Session I     July 20–26, 2008 Name ______________________________________________ Home Address ______________________________________________ City, State, Zip ______________________________________________ Home Phone (_____)_______________________________________ Home Email ______________________________________________ Leadership Position ______________________________________________ Emergency contact (Name & phone) ______________________________________________ T Shirt Size     S     M     L     XL     XXL     XXXL Help us with rooming assignments by providing the following information: Early Bird Night Owl Physical Needs Gender Identity   ________________________________   Request Registrar Contact   Participant Signature   X_____________________________________________

Participant for Session I     July 20–26, 2008 Name ______________________________________________ Home Address ______________________________________________ City, State, Zip ______________________________________________ Home Phone (_____)_______________________________________ Home Email ______________________________________________ Leadership Position ______________________________________________ Emergency contact (Name & phone) ______________________________________________ T Shirt Size     S     M     L     XL     XXL     XXXL Help us with rooming assignments by providing the following information: Early Bird Night Owl Physical Needs Gender Identity   ________________________________   Request Registrar Contact   Participant Signature   X_____________________________________________