2023 LEAD Summit XII Registration

Badge Name

• Prefix: --Choose-- Mr Mrs Miss Ms Dr Prof Rev Fr Sr Rabbi
• * First Name:
• * Last Name:
• Title (space limited, one line only):
• * Email Address:
• * Confirm Email Address:

Guest Information

You may add a maximum of 20

Optional Course Credit

• Are you interested in receiving Professional Development Course Credit (1.0)? --Choose-- Yes No

• You will be contacted with instructions to register for the optional course credit offered through the College of Extended Learning at CSUSB.

Other Information

• We will be providing a free lunch at 12:00 pm. Please let us know if you are planning to stay for lunch? Lunch will be provided to the first 350 people.

  • Yes, I will be staying for lunch. Count me in.
  • No, I will not be staying for lunch.
• Do you require accessibility accommodations? --Choose-- Yes No
• Do you require Spanish language translation services? ¿Requiere servicios de traducción al español? --Choose-- Yes / Si No