Boys & Girls Clubs of America

2017 Midwest/Northeast Leadership Conference Registration

Please Type or Print Legibly in ALL CAPS

Registration Information
First Name (Used for Badge)
Last Name
Title (Required)
Organization’s Region
Organization
Organization Address
City, State, ZIP, Country
Phone: / Fax: Cell:
E-mail:
Spouse First Name and Last Name (Used for Badge)
Boys & Girls Clubs of America affiliation:
BGCA National Staff Board Member CEO Board Chair Guest
Military Organization Professional Staff Speaker Board Member – Thursday Only
First Midwest or Northeast Leadership Conference?
Yes No / If your organization is on a military base, which service branch?
Air Force Army Marine Corps Navy
National Guard Coast Guard
Have you graduated from the Advanced Leadership Program (ALP)?
Yes No
If yes, what date did you graduate? ______
Are You a Club Kid?
Yes No
If so, please enter the name of your home Club ______
Registration Fees / Cost Per Person / Quantity / Amount
Early Bird Registration Fee (Through August 25) / $325
Standard Registration Fee (August 26 – October 9) / $350
Spouse Registration Fee / $125
Onsite Rates (October 24-26)
Onsite Registration Fee / $375
Onsite Spouse Fee / $125
Total Registration Fees: / $
Optional Activities / Cost Per Person / Quantity / Amount
Tuesday, October 24 (8:00am - 12:00pm): Board Transformation Phase 2 (Invite Only) / $0
Tuesday, October 24 (8:00am - 4:00pm): Great Leaders Create Great impact (CEOs & Mangers of Club Directors) / $75
Tuesday, October 24 (8:00am - 4:15pm): InsideOut Coaching (CEOs & COOs) / $75
Tuesday, October 24 (8:00am - 4:00pm): Next Level Strategies for Your Club’s RD Program / $100
Tuesday, October 24 (9:00am - 4:00pm): Taking Your Data Use to the Next Level / $0
Tuesday, October 24 (12:00am - 4:30pm): Board Transformation Phase 3 (Invite Only) / $0
Tuesday, October 24 (10:00am – 4:00pm): Teen Accelerator / $75
Tuesday, October 24 (1:00pm – 4:30pm): Metro Services Forum / $0
Tuesday, October 24 (12:30pm – 4:45pm): RD Accelerator Training (Invite Only) / $0
Tuesday, October 24 (1:00pm – 4:00pm): OJP National Mentoring Programs – Mentoring At Risk & Youth in High-Risk Environments / $0
Wednesday, October 25 (12:15pm – 1:15pm): Exhibitor Luncheon / $0
Thursday, October 26 (12:15pm – 1:15pm): Awards Lunch by TPA / $0
Thursday, October 26 (5:15pm – 6:00pm): Board Member Reception / $0
Thursday, October 26 (6:00pm – 8:30pm): Finale Reception / $0
Total Optional Activities Fees:
Enter Total Fees Below from Registration and Optional Activities / Amount
Registration Fees
Optional Activities Fees
Grand Total Fees:

Are you a Club kid?

Please visit

www.bgca.org/alumni.