Boys & Girls Clubs of America

2017 Pacific/Southwest 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 Pacific West or Southwest 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 (June 1 – July 14) / $325
Standard Registration Fee (July 14 – September 5) / $350
Spouse Registration Fee / $125
Onsite Rates ( September 12-14)
Onsite Registration Fee / $375
Onsite Spouse Fee / $125
Total Registration Fees: / $
Optional Activities / Cost Per Person / Quantity / Amount
Tuesday, September 12 (8:00am - 12:00pm): Board Transformation Phase 3 (Invite Only) / $0
Tuesday, September 12 (8:00am - 4:00pm): Great Leaders Create Great impact (CEOs & Mangers of Club Directors) / $75
Tuesday, September 12 (8:00am - 4:00pm): InsideOut Coaching (CEOs & COOs) / $75
Tuesday, September 12 (8:00am - 4:00pm): Next Level Strategies for Your Club’s RD Program / $100
Tuesday, September 12 (9:00am - 4:30pm): Taking Your Data Use to the Next Level / $0
Tuesday, September 12 (8:00am - 4:45pm): Board Transformation Phase 2 (Invite Only) / $0
Tuesday, September 12 (9:30am – 4:30pm): Board Chair Academy / $75
Tuesday, September 12 (10:00am – 4:00pm): Teen Accelerator / $75
Tuesday, September 12 (1:00pm – 4:45pm): Metro Services Forum / $0
Tuesday, September 12 (12:30pm – 4:45pm): RD Accelerator Training (Invite Only) / $0
Tuesday, September 12 (1:00pm – 4:00pm): OJP National Mentoring Programs – Mentoring At Risk & Youth in High-Risk Environments / $0
Wednesday, September 13 (12:15pm – 1:15pm): Exhibitor Luncheon / $0
Thursday, September 14 (12:15pm – 1:15pm): Awards Lunch by TPA / $0
Thursday, September 14 (5:15pm – 6:00pm): Board Member Reception / $0
Thursday, September 14 (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.