Inclusion Institute Member Registration

Inclusion Institute 2017
Member Registration

Please fill out the information below and click submit. Then select one of the registration options to purchase below.

Contact Information

First Name *

Last Name *

Name for Badge *

Membership Type *

First-time attendee? *

Institution Name *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Position Title *

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

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.) *

Name of Purchaser *

Billing Information

Payment Method *

Credit Card Check

Submit

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). If you need an invoice or email confirmation, please contact our Treasurer, Jenn Rassett

Mail check to:
MCPA Conference
Attn: Jenn Rassett
Director of Student Life and Leadership Engagement
3300 Century Ave North, West 1211
White Bear Lake, MN 55110

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 2017​Member Registration

Contact Information

Demographic Information

Attendance Information

Billing Information

Inclusion Institute 2017
Member Registration