July 2017 Athlete Leadership University Registration Form
Saturday, July 8th – Sunday, July 9th at Slippery Rock University and courses offered are Athlete Representative II and Global Messenger II.
(Attendance at Athlete Representative I or Global Messenger I and submitting practicum’s to Athlete Leadership Coordinator are prerequisites to receive eligibility to attend Athlete Representative II or Global Messenger II.)
Select Course
Required
Local Program/Area
Your answer
Athlete's First Name
Your answer
Athlete's Last Name
Your answer
Athlete's Date of Birth
MM
/
DD
/
YYYY
Athlete's Address
Your answer
Athlete's Phone Number
Your answer
Athlete's E-mail Address
Your answer
Mentor's First Name
Your answer
Mentor's Last Name
Your answer
Mentor's Date of Birth: Please NOTE-Mentors must be 18 years of age of older. Mentors are also chaperons and therefore, cannot be a current or former SO athlete.
MM
/
DD
/
YYYY
Mentor's Address
Your answer
Mentor's Phone Number
Your answer
Mentor's E-mail Address
Your answer
Do athlete and/or mentor require handicap accessibility?
Your answer
Do athlete and/or mentor have any other special needs, including dietary needs? If so, please describe.
Your answer
Do athlete and/or mentor have any housing requests such as early arrival and/or preferred roommate? If so, please describe. Requests are not guaranteed.
Your answer
Manager, please check each statement that you understand and agree with. If any are unchecked, we will follow-up for further discussion.
Required
Name of Manager
Your answer
Manager's Phone Number
Your answer
Manager's E-mail Address
Your answer
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms