2021 NeW Leadership Retreat Application

First Name

Last Name

Chapter

Position

Undergraduate Institution

Graduation Date

Preferred Email

Email Address

Phone

Birthday

Shirt Size

Summer Mailing Address

Street

City

State

Zip Code

Emergency Contact Name

Emergency Contact Relation

Emergency Contact Phone Number

Parent's Email

Parent's Address

Are you applying for a travel scholarship to attend the NeW Leadership Retreat?

YesNo

Travel Information and Travel Scholarship Submission.

In order to receive a travel scholarship, you must book your travel and send confirmation and receipts to Alexis Flowers at alexis@enlightenedwomen.org. Travel does not need to be booked now in order to apply for the travel scholarship. You are responsible for booking your travel.

Arrival Date

Departure Date

Price

Name travel reimbursement check should be made out to.

Address where you want the travel reimbursement sent.

Mode of Transportation

Departing City (including airport if applicable)

I understand the reimbursement check will be sent to me after I attend the retreat.

Check Here

Please attach your completed General and Medical Liability Release.

Please attach your completed Code of Conduct Form.

Please let us know if you are kosher, vegan or vegetarian or if you have any food allergies.

OPTIONAL: Please let us know if you have any questions or ideas for the Retreat.

OPTIONAL: List up to 3 other women you would like to room with at the hotel.

Contact Information