2023 Learning Summit Registration Form Monday, September 18, 2023 – Wednesday, September 20, 2023 Emory Conference Center Hotel 2023 Learning Summit Registration Form Your Institution * Associated Colleges of the South Birmingham-Southern College Centre College Centenary College Davidson College Furman University Hendrix College Millsaps College Morehouse College Rhodes College Rollins College Sewanee: The University of the South Southwestern University Spelman College Trinity University University of Richmond Washington and Lee University First Name * Last Name * Preferred Pronouns * Preferred Name for Nametags (At the Summit, we prefer to use first names rather than formal titles wherever participants are comfortable with that choice.) * Title * What is your role within your institution, if different from your title? * Department * Cell Phone Number (will not be shared) * Email * List any food allergies, restrictions, or preferences. (If any) Emergency Contact Name * Emergency Contact Cell Phone Number * Name of your Project * Reflecting on your ACS/Mellon grant project(s) towards faculty/staff development, if there was one thing about the results of this work or the process of doing this work that you would like to make sure your Dean/President or ACS/Mellon knows, what would that be? * Have you or others from your project team presented work from the project in a presentation, a conference, a publication, or other cite-able work? * Yes No If you are human, leave this field blank. Submit Δ
