45th Annual LACUSPA Conference Registration Form
Please use this form to complete your registration for the conference to be held October 6-7 at Southern University in Baton Rouge, LA. Payment instructions will be present on the confirmation page.
Please indicate: *
First Name: *
Your answer
Last Name: *
Your answer
Job Title: *
Your answer
Institution/Association: *
Your answer
E-mail Address: *
Your answer
Office Phone: *
Include area code, Preferred format: 999-555-5555
Your answer
Mobile Phone:
Include area code, Preferred format: 999-555-5555
Your answer
How many years have you worked in higher education (excluding graduate assistantships)? *
Your answer
Institution's LACUSPA Membership Status *
What is your PRIMARY area of student affairs? *
If you oversee multiple areas, please select the area of professionals you would like to network with at the conference.
Will you be attending the Welcome Reception on the night of Sunday, October 6? *
The reception will include a full-spread, buffet-style catered meal and a networking opportunity with conference attendees.
Dietary Accommodations *
Add any other accommodations we should consider. We will do our absolute best to meet your meal accommodations or communicate with you in advance of the conference.
Required
Please indicate any other special accommodations you require.
Your answer
Within 2-4 business days, you will receive an invoice for your registration. Would you like your invoice to be grouped with other recent registrants from your institution? *
Invoices can be paid by credit card or a check/money order may be mailed to address indicated on the invoice.
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