Deposit Form
$150 for mentee($100 for adult guests and $50 or children under 13)Hotel and Travel is not included. The rate covers all activities and meals for the weekend.
Full Name (Mentee)
*
First Name
Last Name
Additional Guest Name (Deposit of $100 or $50 for guest).
First Name
Last Name
Additional Guest Name (Deposit of $100 or $50 for guest).
First Name
Last Name
Additional Guest Name (Deposit of $100 or $50 for guest).
First Name
Last Name
Additional Guest Name (Deposit of $100 or $50 for guest).
First Name
Last Name
Additional Guest Name (Deposit of $100 or $50 for guest).
First Name
Last Name
E-mail
*
example@example.com
Phone Number
*
Format: (000) 000-0000.
Address (City, State, Zip)
*
Business Name
*
T-Shirt Size (Only for mentees - T-shirts will be available for sell for guests at the event)
*
Any dietary restrictions?
*
Room Type? For room block (Hilton Memphis or Hampton Inn and Suites Germantown)
*
Single (3 people)
Double (5 people)
Accessibility
Cohort?
*
1
2
3
4
5
6
7
8
9
Would you like to volunteer - Someone from the committee will contact you?
*
Host (Thursday and Friday night)
Presenter for Professional Development Day - Friday (9-3)
Clean Up and Set Up for weekend
Speaker for Banquet (Friday night)
Not interested
My Products
prev
next
( X )
Business Mentee
$150.00
$
150.00
Additional Child Guest
Kid age 13 and under
$50.00
$
50.00
Quantity
1
2
3
4
5
Additional Adult Guest
13 and older attendee
$100.00
$
100.00
Quantity
1
2
3
4
5
6
7
8
9
10
Submit
Should be Empty: