2017 Summer Leadership Conference: Staff Position Fee Request

Please use this form to make a payment towards the Staff Position offered to your student. We ask for $250 to help cover the cost of room / board / all supplies and workshop costs.

Contact Information of Person making Payment

What is your relationship to the Staff Member

Salutation

First Name

Last Name

Phone No.

Email Address

Street Address

City

State

ZIP Code

Please credit $250 towards:

Staff Member's First Name

Staff Member's Last Name

Amount to Pay today

After you click SUBMIT, you will be taken to PayPal to submit payment for this Staff Member.
A confirmation of this payment will be sent to the email address noted above.

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