University Staff Senate

Council of Councils Registration

Please complete the information below.  Once the form is completed, click the button located at the bottom of the form.  If you prefer to print and either e-mail or fax your registration form, you may click on this link for the form. 

http://www.siue.edu/ugov/staff/pdf/Council_of_Councils_Registration.pdf

Contact Information

Emergency Contact Information

Please list the name, phone number, and relationship of a person we can contact in case of an emergency.

Topics of Interest

Please list below any topics of interest that you would like discussed at the Council of Councils.

Breakfast Order (please select one)

I will attend breakfast

I will not attend breakfast

Vegetarian meal preferred

I have special needs or dietary restrictions

Lunch Order (please select one)

I will attend lunch

I will not attend lunch

Vegetarian meal preferred

I have special needs or dietary restrictions

Please indicate any dietary restrictions or allergies

Please indicate any special needs

I will need SIUE parking accommodations.                                                                YES     NO

I will be staying overnight at The Country Hearth Inn and Suites.                               YES     NO

I will be joining the SIUE Staff Senate Thursday October 22, 2009 for Dinner.             YES     NO   

I will be joining the SIUE Staff Senate Thursday October 22, 2009 for Entertainment.  YES    NO