2019 - 2020 Peer Education Registration
Registration Fee: $5.00 per team member
(Includes: Certificate and Pin at State Leadership Conference)
Email address *
Chapter Name *
Your answer
Chapter Adviser *
Your answer
Do you need an invoice prior to the close of the registration period? *
TEAM REGISTRATION
Please submit a new form for EACH team you are registering for your chapter. A team may be comprised of anywhere from one (1) to five (5) members.
Select the Peer Education team for which you are registering a team. *
Select the team number from your chapter which you are registering. *
Team Member #1 - Name *
Your answer
Team Member #1 - E-mail *
Your answer
Team Member #2 - Name
Your answer
Team Member 2 - E-mail
Your answer
Team Member #3- Name
Your answer
Team Member #3 - E-mail
Your answer
Team Member #4 - Name
Your answer
Team Member #4 - E-mail
Your answer
Team Member #5 - Name
Your answer
Team Member #5 - E-mail
Your answer
CONFIRMATION
I understand that once registration closes my chapter will be invoiced for all members I have registered for Peer Education. *
Required
I understand that once I register a member for Peer Education I am NOT able to cancel their registration; however, I can switch them to another team. *
Required
A copy of your responses will be emailed to the address you provided.
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