Oregon Student Association

20th Anniversary Northwest Student Leadership Conference Registration

Hilton Executive Tower, Portland Or.
January 29-31, 2010

Registration is now closed. Stay tuned for information and details for NWSLC 2011!

Fields marked with a * are required.

School Name *

Group Name *

Address *
City *	State *	ZIP *

Delegation Leader *

Leader Phone *

Leader Email *

Staff Member/Adviser In Charge of Making Payments *

Phone *

Email *

Registration Pricing

	Early Registration (Now-01/15/10)	Regular Rate (01/16/10-01/25/10)
OSA Member Non-Member	$95 $105	$105 $115
OSA Member Schools	Mt. Hood Community College, Lane Community College, Oregon State University, University of Oregon, Eastern Oregon University, Southern Oregon University, Western Oregon University, Portland State University, Oregon Health & Science University

Number Registering *
(Include Delegation Leader)

Members
x $95.00 = $

Non-Members
x $105.00 = $

Total People

Total Dollars
$

Students Attending *
(Each Name On A Separate Line)

NWSLC T-Shirt Pre-Order (Enter Quantity)
Small
Medium
Large
XL
XXL

Total T-Shirt Quantity x $10.00 = $

Number of Vegetarians

Number of Vegans

Other Dietary Needs (Explain)

ADA Needs (Explain)
(To ensure we meet these needs students with
ADA requirements must register by Oct. 5)

Total To Be Invoiced For Registration and T-Shirts * $

Join the NWSLC Steering Committee Oregon Student Foundation

Contact Info

Oregon Student Foundation
635 NE Dekum St.
Portland, OR 97211
Phone: 503-286-0477
Fax: 503-286-0924 Email:(JavaScript must be enabled to view this email address)

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