Boys & Girls Clubs of America

2016Midwest Leadership Conference Registration

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Registration Information
First Name (Used for Badge)
Last Name
Title (Required)
Organization
Organization Address
City, State, ZIP Code
Phone: / Fax: Cell:
E-mail:
cc E-mail Address:
Spouse First Name (Used for Badge): / Spouse Last Name:
Boys & Girls Clubs of America Conference Category:
CEO Board Chair Board Member Professional Staff Club Directors Institute Guest
Learning Team Questions
Professional Staff, what is your current position with your Organization?
Volunteer Program Staff Program Director Unit Director Senior Staff
Support Staff Executive Director
Is this your firstMidwest Leadership Conference?
YesNo / Which budget class does your Organization (not unit) fall within?
Less than $250,000 $250,000 - $399,999 $400,000 - $599,999
$600,000 - $999,999 $1,000,000 - $2,499,999 $2,5000,000 - $4,999,999
$5,000,000 - $7,499,999 $7,500,000 - $9,999,999 $10,000,000 and above
If your Organization is on a military base, which service branch?
Air ForceArmyMarine CorpsNavyNational GuardCoast Guard
What is your primary area of work?
Executive Leadership Finance Human Resources Marketing Operations Program Property
Resource Development
How long have you held your current position?
Less than 1 year1 – 5 years6 – 9 years 10+ How long have you been in the Movement? ______years
In 2016, please select the topic that has the highest priority for you and your Organization:
Board Development Talent Management
Resource Development Outcome Measurements / Have you graduated from the Advanced Leadership Program (ALP)?
No Yes
If yes, what date did you graduate? ______
Registration (Deadline is September 15 at 11:59pm) / Cost Per Person / Amount
Standard Rates
Early Bird Registration Fee (through August 19) / $325
Standard Registration Fee(August 20 through September 15) / $350
Spouse Registration Fee / $125
Board Member – Thursday Only / $150
Onsite Rates(After September 15)
Onsite Registration Fee / $375
Onsite Spouse Fee / $125
Total Registration Fees: / $
Optional Activities / Cost Per Person / Amount
Tues, October 4–Please select which session(s) you will attend:
InsideOut Coaching (Invite Only) (8:00a to 1:00p) / $50
Data Use for Improving the Club Experience (8:00a to 5:00p) / $0
Next Level Strategies for Your Club’s RD Program (8:00a to 5:00p) / $100
Teen Accelerator (10:00a to 4:00p) / $50
OJP National Mentoring Programs (1:00p to 4:00p) / $0
Major Metro Forum (1:00p to 5:00p) / $0
Wed, October 5 - Please select if you will attend:
Exhibitor Luncheon (12:45p to 1:45p) / $0
Thurs, October 6 – Please select which you will attend:
Board Member Breakfast (7:00a to 8:00a) / $0
Awards Luncheon by TPA (12:15p to 1:15p) / $0
Board Member Reception (5:30p to 6:15p) / $0
Heart & Soul Dinner (6:30p to 8:30p) / $35
Total Optional Activities Fees: / $
Enter Total Fees Below from Registration and Optional Activities / Amount
Registration Fees / $
Optional Activities Fees / $
Grand Total Fees: / $