Values Guided Leadership - GLLA Leadership Intensive

I'm a GLLA Alum

Required fields are indicated with an asterisk (*)

Alumni Member Registrant Information

* First Name

* Last Name

Pronouns

* Address

Addt'l Address

* City

* State

* Country

* Zipcode

* Phone Number

* E-mail If you supply an e-mail address, a receipt for your registration will automatically be sent to that account. An e-mail address is required to pay using a credit card.

* Please list the year and program that you attended GLLA Please list your year and cohort

Registration Information

* I would like to register for this Great Lakes Leadership Academy Leadership Intensive ($120.00)

Photo/Audio/Video Release I authorize Michigan State University to record my image and voice (or that of my minor child named here) and give Michigan State University and all persons or entities acting pursuant to MSU's permission or authority, all rights to use these recorded images. I understand that said images will be used for educational, advertising and promotional purposes in all conventional and electronic media, and any future media. I also authorize the use of any printed material in connection therewith. I understand and agree that these images and recordings may be duplicated, distributed with or without charge, and/or altered in any form or manner without future/further compensation or liability, in perpetuity.

* Please Indicate your authorization

Contact Information

For information, contact Kara Kelly at glla@msu.edu.