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NELD Registration Form: 2018
Please use this form to register your state's 2018 NELD Program participants. The deadline is Friday, September 15, 2017. Remember to submit the name, title, and contact information (address, phone, and email) of each participant from your state on this form.

NOTE: To help ensure a quality learning experience for all participants, we will once again be capping the 2018 cohort size at 36 participants. Each of the 12 states in the region will be guaranteed up to three spots, and can list up to two alternates (in ‘priority order’). Immediately after the 9/15/17 deadline, we will review registrations received and fill any remaining spots with alternates -- selected one at a time per state on a first-come, first-served basis according to the date of the state’s initial registration. We will assume all alternates listed are approved to participate. We'll confirm the final number of participants from each state on or before September 26.

If you have comments or questions about this registration process, please contact Holli Arp (507-372-3900 or arpxx001@umn.edu).

Your University:
Your answer
Name of person completing this form:
Your answer
Your State Contact:
Please include name, title, address, phone and email.
Your answer
Invoicing Contact:
Please include name, title, address, phone and email. NOTE: If this is the same person as the state contact (noted above), please indicate that by typing "same" in the space below.
Your answer
Number of NELD participants from your state in 2018:
Number of "alternates" from your state in 2018:
Indicate number of participants (0-2) you would like to register if additional space is available.
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