First Name *

Last Name *

Are you a current member of the Hauenstein Center, CLA Fellow, or CLA Mentor? *
- Select Option Yes No I'm not sure

Please call the Hauenstein Center at (616) 331-2770 to verify your membership status

Email *

Phone *

Address 1 *

Address 2

City *

State *
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Zip/Postal *

Will you be attending the event in person or virtually? *
- Select Option Attending in person Virtually

Are you interested in participating in the "Community Conversation" reception which will begin immediately following the public lecture in assigned round tables followed by open networking? *
- Select Option Yes No

What is your connection to the Peter C. Cook Leadership Academy? *
Alumni
Mentor
Community Member
Hauenstein Center Member
GVSU Student
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What is your profession or field of study? *

Would you like more information from the Hauenstein Center?
Please add me to the Hauenstein Center Mailing List
Please send me information on Hauenstein Center membership

How did you hear about this event? *
Email
Facebook
Postcard/Member Invite
GVSU Poster/Banner
Lanthorn
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First Name *

Last Name *

City *

Are you interested in participating in the "Community Conversation" reception which will begin immediately following the public lecture in assigned round tables followed by open networking? *
- Select Option Yes No

What is your connection to the Peter C. Cook Leadership Academy? *
Alumni
Mentor
Community Member
Hauenstein Center Member
GVSU Student
Not listed Please specify a value for What is your connection to the Peter C. Cook Leadership Academy?

What is your profession or field of study? *

First Name *

Last Name *

City *

Are you interested in participating in the "Community Conversation" reception which will begin immediately following the public lecture in assigned round tables followed by open networking? *
- Select Option Yes No

What is your connection to the Peter C. Cook Leadership Academy? *
Alumni
Mentor
Community Member
Hauenstein Center Member
GVSU Student
Not listed Please specify a value for What is your connection to the Peter C. Cook Leadership Academy?

What is your profession or field of study? *

First Name *

Last Name *

City *

Are you interested in participating in the "Community Conversation" reception which will begin immediately following the public lecture in assigned round tables followed by open networking? *
- Select Option Yes No

What is your connection to the Peter C. Cook Leadership Academy? *
Alumni
Mentor
Community Member
Hauenstein Center Member
GVSU Student
Not listed Please specify a value for What is your connection to the Peter C. Cook Leadership Academy?

What is your profession or field of study? *