Quickribbon 2009 LI Registration – GlobeMed

2009 Leadership Institute Registration Form

Date & Time

Start: 2:00PM Friday, September 11th

End:12:00PM Sunday, September 13th

Location

Evanston, IL at Northwestern University (just north of Chicago)

Cost:

$20 fee that will help support lodging and food for participants during the Institute.

Registration Deadline:

August 16th at Midnight

More information:

Click here for more information about the Leadership Institute. Still have questions? Contact: chapter@globemed.org

Up to three leaders from each chapter are encouraged to attend. Ideally, one 'seasoned' Co-President and one younger eboard member. EACH person must register individually by filling out the form below.

(required *)

Personal Information



Sex*:



Involvement In GlobeMed

Year of Graduation*:

GlobeMed Chapter*:

Your position last year*:

Your position this year*:

Leadership Institute Information

Please note that your arrival flight (or other transportation) should arrive in Chicago no later than 12:00PM on Friday, September 11th, and your departure flight should be scheduled to depart after 3:00PM on Sunday, September 13th in order to allow full attendance at the Institute. Lunch will be provided on Friday for those arriving before 2:00PM.

Expected Arrival Date*:

Estimated Arrival Time*:

Expected Departure Date*:

Estimated Departure Time*:

Question 1*: Why would you like to attend the Leadership Institute?
(Please keep all answers under 10 sentences):

Question 2*: What are the most difficult challenges you face in leading GlobeMed at your university?


Question 3*: How do you plan to bring back the skills and ideas you learn at the Leadership Institute to your chapter?


Travel Award(optional)

Are you requesting a travel award?:

If you are requesting a travel award, please answer the following questions:

How much(up to $150) are you requesting?:

Briefly explain your travel need (including estimated costs of transportation to the LI and your itinerary):

After clicking the form submission button below, you will be taken to the payment page. Please make your payment immediately in order to ensure your registration is complete. If personal circumstances make payment of the $20 fee difficult for you, please contact Ashley at: chapter@globemed.org