Florida African-American Student Assocation, Inc

FAASA  2017 FALL LEADERSHIP INSTITUTE
November 9 - 12, 2017
Daytona Beach, Florida
 


Name of Institution:   *   

Campus:      Name of Chapter:   



Name of Advisor:   *   

Advisor's Address:s:    City:    Zip:  

Telephone:  *        Fax:     Email:  *     


Name of Chapter President:    *   

President's Address:     City:    Zip: 

Phone: *        Fax:    Email:  *     

Number of Students   at $125 per registrant
Number of Advisors at $125 per registrant
Number of Breahfast Ticket(s) ONLY at $25 per ticket for non-registrants
Number of Banquet Ticket(s) ONLY   at $50 per ticket for non-registrants
Number of Luncheon Ticket(s) ONLY at $35 per ticket for non-registrants
Annual Chapter Membership Dues at $150 annually
Development Foundation Donation $ optional
Total (Calculate when Submitted)  
# of  Hotel Rooms Utilized   (Before releasing rooms back to the hotel, please notify Don Cleveland at dcleveland@faasaweb.org)

Please List The Names Of All THE Attending Delegates
 (Do Not Include the Above Listed Advisor and President)
Delegate: Office:
Delegate: Office:
Delegate: Office:
Delegate: Office:
Delegate: Office:
Delegate: Office:
Delegate: Office:
Delegate: Office:
Delegate: Office:
Delegate: Office:
Delegate: Office:
Delegate: Office:
Delegate: Office:
Delegate: Office:
Delegate: Office:
Delegate: Office:
Delegate: Office:
Delegate: Office:
Delegate: Office:
Delegate: Office:
Complete ALL Fields including (Required Fields [*])