CIC Academic Leadership Program
Seminar I: Leadership for Excellence
Purdue University
October 5-7, 2006
Please use the form below to register for the ALP Seminar.
Personal Information
First Name:
Last Name:
Badge Name:
Institution:
Phone Number:
Fax Number:
Email Address:
Do you plan to attend the ALP Seminar?
Yes
No
If no, please explain:
If you require any special accomodations, please describe:
Hotel Information
Please check all evenings for which you need overnight accommodations. If additional nights are requested either before or after the four nights indicated, responsibility for payment rests with you or your home institution. Also please indicate your preference for a smoking or non-smoking room, and let us know about any special accommodations that you need.
Wednesday, October 4:
Thursday, October 5:
Friday, October 6:
Saturday, October 7:
Room Type:
Non-Smoking
Smoking
Will you require parking?
Yes
No
Meal Options
If you have any special dietary needs, please describe:
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Committee on Institutional Cooperation • 1819 South Neil Street, Suite D • Champaign, IL 61820-7271
Phone: 217.333.8475 • Fax: 217.244.7127 •
Email: cic@uiuc.edu
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