Keep a Child Alive presents Student AIDS Summit 2008

Your Details

First Name

Last Name

Address

City

Country

State

Zip Code

Phone

Age (as of November 13, 2008)

Are you a Leader/Member of an official KCA College Chapter?

Yes

Which group do you represent, if any?

Which Chapter?

Year of Graduation

Tshirt Size

Food Restrictions

Food Allergies

Upload headshot photo

Select "browse" to locate the image on your computer or network. The photo you upload should be no more than 250 pixels wide, and must be in GIF or JPEG format

Personal Statement

What is the biggest obstacle to doing meaningful AIDS work on campus? How do you plan to overcome that obstacle? Please respond in 50 words or less.

The Black Ball

Please indicate below if you will attend the KCA Black Ball on Thursday, November 13th at the Hammerstein Ballroom in New York City. Exclusive KCA College Member Tickets are only $25.00 and must be paid for prior to arrival at the Summit.

Please send a $25.00 check payable to "Keep a Child Alive", with "KCA College - BB" written on the Memo Line. Please send checks to: Keep a Child Alive; Attention: KCA College BB; 45 Main Street Suite 720, Brooklyn, NY 11201

Will you attend the Black Ball?

Yes

Travel Details

The KCA Student AIDS Summit 2008 will be hosted by Keep a Child Alive in New York City, with much of the Summit based at the New York University Kimmel Center (see map)

Please check one box:

I will be flying to a NYC-area airport.

I will be traveling via train or bus to a NYC-area train station or bus terminal.

I will be traveling by car, public transportation, or I already live in NYC.

Here are my travel details:

Date of arrival:--:

Arriving airport:

Arriving airline and flight number:

Lodging Details

Please check one box:

I will stay at a KCA Partner Hostel in NYC for $38 per night. (Further instructions will be sent to you by Oct. 3rd, 2008 however your space at the Hostel will be saved if you choose this option.)

I am interested in being hosted by a local KCA College Member in NYC (Limited availability. Participants will be lodged with a local KCA College Member on a first-come first-serve basis, and only as lodging becomes available. If we cannot make this arrangement for you, we will recategorize you as staying at the Partner Hostel.)

I will stay with a family member/friend or find and fund my own accommodations.

Emergency Contact for the dates of Nov 13 - 15th, 2008:

Emergency Name

Emergency Relation

Emergency Phone

Emergency Phone 2

Summit Workshop Preferences

Please check your top three Workshop topics of interest:

Keep a Child Alive presents:Student AIDS Summit

REGISTRATION