ADVISER INFORMATION
Name
*
First Name
Last Name
Name (As it will appear on name tag)
*
Gender (Please Specify)
*
Pronouns
*
Email Address
*
College/University you represent
*
Are you able to present an ART program?
*
Yes
No
T-Shirt Size (please check one)
*
X-Small
Small
Medium
Large
X-Large
XX-Large
XXX-Large
Dietary Needs
*
Kosher
Dairy Free
Gluten Free
Vegan
Vegetarian
None
Other
Would you like to opt into gender neutral housing?
*
Yes
No
Please select if you would like a single or shared room (this does affect price per advisor)
*
Single
Shared
Roommate request if in shared room:
Special Needs- Do you have any special needs during the conference (i.e. accessibility, housing, etc.)? If yes, please specify.
*
Medical Needs- Do you have any special medical needs during the conference? If yes, please specify.
*
Emergency Contact
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Relationship
*
Insurance Information
Provider
*
Policy Number
*
Providers Phone Number
*
-
Area Code
Phone Number
Submit
Should be Empty: