Inclusion Institute Member Registration

Inclusion Institute 2019
Registration Page

Contact Information

* Indicates required field

First Name *

Last Name *

Name for Badge *

Membership Type *

First-time attendee? *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Institution Name *

Email *

Phone Number *

Social media (Facebook, Twitter, Instagram) will be utilized during the conference. If you would like, please provide your Twitter and/or Instagram handle for inclusion in the conference group and live Twitter Feed screen. This will also allow you to find and follow other conference attendees

Twitter handle (e.g. @MCPA): *

Instagram handle (e.g. @MCPA): *

Demographic Information

In an effort to best serve the higher education community, MCPA has started collecting demographic information at all events. These questions are not required and responses are not selected from a pre-determined list. You are able to fill in your own response. MCPA will use this data to better understand the community we are supporting and identify the needs of that community leading to continued quality events and engagement.

Race and/or Ethnicity *

Disability Status *

Gender Identity *

Number of years in higher education *

Functional Area *

Institution Type *

Education Level *

Age *

Sexual Orientation *

Veteran Status *

Attendance Information

Name of Purchaser *

Billing Information

Payment Method *

Credit Card Check (If Paying By Check: once you hit submit, you are finished. You will NOT receive an email confirmation (this is only sent if paying by credit card).

Do you require accommodations to participate in the event (including disability parking)? If yes, please describe the nature of the request below. *

What dietary options should be provided for you? *

I have no specific considerations to note Please see my specific dietary considerations noted in the prompt to the right Gluten Free Vegetarian Vegan

Do you have other, more specific dietary considerations (allergies, guests that keep kosher, Halal meals, etc.) *

Submit

If you need an invoice or email confirmation, please fill out the request for invoice form.

Mail check to:

MCPA Inclusion Institute
Attn: Domingo A. Coto
1122 University Avenue SE
Minneapolis, MN 55455

Checks should be made out to Minnesota College Professionals Association. Please also include the name of who you are paying for on the check (if there are multiple people, please list on a separate piece of paper and include with the check).

Refund Policy
MCPA annual memberships may not be refunded.

Inclusion Institute 2019Registration Page

Contact Information

Demographic Information

Attendance Information

Billing Information

Inclusion Institute 2019
Registration Page