Fort Hays State University

Fall 2004 Collegiate Leadership Institute
Application

Please take a moment to fill out this application and then click the submit button. You may also download the application and mail it to the address listed below or call to register at 785.628.5592.

This event will take place in April of 2005

Participant Information

University You Currently Attend
Name (First, Middle, Last)
Mailing Address
City
State
Zip Code
Phone Number
E-mail address
Special Needs
Method of Payment (Fees are $75.00 per participant)	Check Money Order (Please mail to address below and make payable to Center for Civic Leadership)
How did you hear about the Collegiate Leadership Institute? (optional)
You will receive a confirmation of registration within 10 days of submitting information. Registration fees will be refunded if cancelled before the deadline date. For any questions concerning this form or CLI please contact: Center for Civic Leadership 208 McCartney Hall 600 Park Street Hays, KS 67601 (785) 628 5592 jlewis@fhsu.edu Thanks for Registering!



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