Kentucky Parent Leadership Summit

Saturday, April 28: 10:00 am to 4:00 pm

Bluegrass Community and Technical College
500 Newtown Pike
Lexington, KY 40508

For more information call 859-233-9849 or email syates@prichardcommmittee.org

Bluegrass Community and Technical College

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REGISTRATION FORM
First Name
Last Name
Phone Number
Address
City
State
ZIP
Are you a CIPL / GCIPL Fellow?
What Year?
Have you attended a Basecamp in NKY?
PHOTO/VIDEO WAIVERI hereby grant the Prichard Committee for Academic Excellence permission to use my likeness in photograph(s)/video in any and all of its publications and in any and all other media in perpetuity for promotional and educational purposes. I will make no monetary or other claim against the Prichard Committee for Academic Excellence for the use of the photograph(s)/video.
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