Dec 16, 2025, 20:46

Individual Registration

Please enter information in the form below to process your registration for the Deans and Directors Retreat / Leadership Conference.

First Name *

Last Name *

Organization/School *

Your Job Title

Address must match credit card billing address, when paying by credit card.

Billing Address *

City *

Zip *

Country *

State *

Phone *

Email *

Comment or Other Address / School Address you want mail sent to if different than billing address.

Extra Info

Payment Information

Amount

$

Discount Amount

$

Gross amount

$

Payment Method *

Authorize.net Please Bill Me

Credit Card Number*

Expiration Date*

/

Card (CVV) Code*

Card Type*

Card Holder Name*

Verification code*