The University of Kansas

Native American Leadership Symposium

November 15, 2013
REGISTRATION FORM
Mail to:
Office of Multicultural Affairs
1299 Oread Ave
Lawrence, KS 66045
Group Name:________________________________________________________
If you are an individual registering for the symposium, please enter Individual for Group Name, and
then list your name as the sponsor.

Street: _____________________________________________________________
City: ________________________________State: ______Zip: _____________
Sponsor Last Name: __________________Sponsor First Name: _________________
Email: ______________________________Phone: _________________________
Number of Students: __________________________________________________
Note: Please include a spreadsheet containing the following information about your
students:
Student Full Name
Grade
School
Date of Birth
Graduation Year
Additional Sponsors or Chaperones:

__________________________________________________________
__________________________________________________________
Special Accommodations for Participants:

__________________________________________________________
__________________________________________________________
Cost per student: $18. Cost per counselor/advisor: $20.
Please include money/purchase order when registering.

Please contact Ashley Tso at ashley.tso@ku.edu for more information or questions.

All registration forms are due by November 1, 2013.