United States Student Association National Student Power Summit Delegation Registration Form
We are happy to invite you to the 2017 National Student Power Summit taking place March 31st- April 3rd, 2017. With the increased attacks on marginalized communities and a new administration, it is more important than ever to ensure that we as students are prepared to fight for education justice at our universities and within our communities. We have the power to put pressure on the systems of inequality that effect students everyday. From the demilitarization of campus police and immigration reform to the fight for free public college and a living wage, we can demand change for students. We hope that you will join us, and students all around the country, in showing solidarity with and empowering one another.

Please submit this form to reserve your spot at National Student Power Summit 2017 and fill out all questions completely. The deadline to submit your group registration is March 6th, 2017. The conference will be held at American University College of Law located at 4300 Nebraska Ave NW Suite C303C.

Email address
Delegation Information
In what region is your campus located?
In what state or territory is your campus located?
Your answer
Delegation: Which campus, statewide student association, or organization is your delegation representing
Please type the full name of your campus, statewide student association, or organization.
Your answer
How many delegates will be in your delegation?
How many students will be part of your group? NOTE: USSA is committed to recruiting a diverse group of students to work on a broad range of topics and build student power. We encourage you to reach out to student organizations including women; students of color; lesbian, gay, bisexual, or transgender students; veterans; students with disabilities; and nontraditional students and invite them to join us at National Student Power Summit and in this work.
Your answer
Delegation Leader: First Name
Your answer
Delegation Leader: Last Name
Your answer
Delegation Leader: Phone Number
Your answer
Delegation Leader: Email
Your answer
Delegation Billing Information
IMPORTANT NOTE: Once registration is submitted, delegations are financially responsible for the number of delegates they list above, even if they are not able to attend the National Student Power Summit. Please provide information for your delegation's billing contact below.
Billing Contact Information: First Name
Your answer
Billing Contact Information: Last Name
Your answer
Billing Contact Information: Email
Your answer
Billing Contact Information: Phone Number
Your answer
Registration Fees and Deadlines
Please submit your payment by the deadline to complete the registration process. Failure to pay for early registration or regular registration ON TIME may result in a higher registration fee. If we have not received your payment by March 6th, you will not be able to attend the National Student Power Summit.

Fees:
Early Registration: USSA Members $175, Statewide Student Association $200, Non-member $225
Regular Registration: USSA Members $225, Statewide Student Association $250, Non-member $275
Late Registration: USSA Members $250, Statewide Student Association $275, Non-member $300

Deadline to pay Early Registration: February 3rd, 2017
Deadline to pay Regular Registration: February 17th, 2017
Deadline to pay Late / All Registration: March 6th, 2017

Registration Fee: Early Registration (Ends February 3rd )
By submitting this form, I agree to pay the full amount corresponding to the number of delegates specified above.
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