The 2007 High School Leadership Conference at Hiram College

Registration/Nomination Form

Nominator Information:

If you are a high school teacher, staff member or guidance counselor, please provide your contact information so that we may reach you.

First name:
Last name:
Title:
High School:
Phone:
Email:

Nominee Information:

Please use the space below to nominate two students who will be seniors in the fall of 2007 for the High School Leadership Conference (HSLC). We assume you are nominating students who you have spoken with about the Conference and who show an interest in attending.
SPACE IS LIMITED, SO PLEASE REGISTER EARLY.

1st Student's Information:

First name:
Last name:
Address:
City:
State:
Zip code:
Phone:
Email address:
Grade Level in fall 2007:
Leadership Positions Held:
Honors or Accomplishments:
T-Shirt Size:

2nd Student's Information

First name:
Last name:
Address:
City:
State:
Zip code:
Phone:
Email address:
Grade Level in fall 2007:
Leadership Positions Held:
Honors or Accomplishments:
T-Shirt Size: