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Register for a Chapter Retreat

Submitted by brome on 4 January 2009 - 1:02am.

Chapter Retreats 2009

Thank you for your interest in STAND’s 2009 Chapter Retreats! Before you register, please make sure to read your Chapter Retreat’s Important Details page for information on housing options, conference fees, and more.

NOTE: IF YOU ARE A STANFORD STUDENT you must register through the Stanford site at instead of here.

Your Information

First Name: *

Last Name: *

Sex: *

Phone Number: * (XXX-XXX-XXXX)

Email Address: *

Year in school: *

I am a: *

School Name: *

School City: *

School State: *

School Zip Code: *

If your home address is different than your school address, please fill out your home contact information

Home City:

Home State:

Home Zip Code:

What is the zip code in which you are registered to vote?:

Chapter Retreat Options

Which chapter retreat are you planning to attend?: *

Will you need housing? (Chapter Retreat attendees will be housed with local college students for free. If you are high school student, please check the Important Details page of your Chapter Retreat to see if you are eligible for free housing):

Yes

No

By answering "yes," you have agreed to the details associated with this agreement, which can be found on your Chapter Retreat’s Important Details page

If you answered “yes” to the above question, for which nights will you need housing?:

Friday

Saturday

Please select from the following options. "I would prefer to be housed with a...":

Male

Female

Doesn't Matter

Do you understand the terms of staying in STAND-arranged housing? (Please see the list of Important Chapter Retreat Details):

Yes

No

Additional Information

Do you have any allergies? If yes, please list:

Do you have any ongoing medical or psychological conditions? If yes, please list:

Are you currently taking any medication(s)? If yes, please list:

Who should we contact in the case of an emergency?:

How is this main contact related to you?:

Main contact's phone number: (XXX-XXX-XXXX)

Special dietary needs (vegetarian, vegan, kosher, etc.):

Please indicate any special needs or arrangements you that you may need during the chapter retreat, or during your stay at the chapter retreat location:

Terms of Agreement:

I understand that my spot in the chapter retreat is not reserved until I submit my $15 registration fee online.

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