Summit Registration
PAYMENT BY CHECK
Summit Cost:
$25 per person
Make checks payable to INRN and send to:
United Way of Greater Lafayette/ INRN
1114 East State Street
Lafayette, IN 47905
If you have any payment/registration questions or need to cancel, please contact Amy at awood@uw.lafayette.in.us or 765-742-9077 x 222.
ALL information is required.
Step 1:
Registration is provided by the INRN West.
Our Kids Are Our Community!
First & Last Name:
Email:
Phone:
Organization:
Organization Address:
City, State, Zip:
County:
Please indicate if you would like to be added to the INRN email list serve:
Do you prefer a vegetarian meal:
Emergency Contact Name:
Emergency Contact Phone:
If more than one person is attending the summit, please list their names and emails below:
Comments or special accommodations:
