Thank you for your interest in the 2009 Black Leadership Conference. If you would like to register for the conference, please complete the following form.

First Name: Last Name: City/State/Zip: ,   Email Address: Phone Number: () Age: Under 15   15-17   18-20   21-23   24-26   27-30   31-35   36-40   Over 40 Are you still in school? Yes   No If Yes what school, major, and degree are you pursuing? School Name: Major: Degree Pursuing: Highest Degree Obtained: None   High school Diploma   BS/BA   Masters   PhD Number of prior Black Leadership Conferences Is your employer or school sponsoring your attendance at this event? Yes   No Are you unable to consume any foods? Beef Pork Chicken Other May we contact you about your conference experience? Yes   No Please submit your resume: Registration Type: Full Conference Admission $15.00 for Ga. Tech Students $40.00 General Admission Friday Conference Admission $25.00 One Day Admission Saturday Conference Admission $25.00 One Day Admission Sunday Conference Admission $25.00 One Day Admission Payment At the door