Registration Form - CULead 2017


January 20-21, 2017
Deadline: Friday, January 6, 2017

This conference requires a $50.00 registration fee. Your registration cannot be confirmed until your credit card information is processed or payment is received in the mail. Registrations are not refundable after the registration deadline. For more detailed information about CU LEAD, please visit the conference website or call 1-877-CEDARVILLE (233-2784).

Please note! To enable us to care for medical needs that arise during CU LEAD, each student must bring a medical release form signed by a parent or guardian when they come to campus. Print the medical release form now.

Note: Red * text indicates required fields

Note: If you have a valid CedarNet account, you may login now to fill in demographic information.

Registrant Information

Title, First Name, Last Name: *
Birthdate *
Address One: *
Address Two:
City, State, Zip Code: *
Phone Number [999-999-9999]: *
Email Address: *

School Information

Name of School: *
City, State: *

Church Information

Name of Church: *
City, State: *

Event Registration

Enter your invitation code:

Campus Housing

Need Housing? *
Please house me with this Cedarville student:
Special Housing Needs
Please let us know of any disabilities/medical conditions that would require special housing needs.

Special Dietary Needs

Please let us know of any allergies that would require special meals to be prepared for you in our cafeteria. All special meal requests must be accompanied by a letter from your doctor.

Travel Plans

We plan to arrive: *   
(Check-in will be located in the Stevens Student Center)

Campus Visit

Campus Visit *   
Total people attending including yourself (Please include any parents or siblings who plan to attend the campus visit with you.)

Pre-Conference Leadership Session

Plan to attend? *   

Other Plans

*As a courtesy to our prospective students who are visiting campus for events, the Admissions department subsidizes airport transportation costs. We offer service to and from the Dayton and Columbus airports at a discounted rate of:

Dayton-$45 round trip
Columbus-$80 round trip

If you plan to travel by air and need transportation to and from the airport for CU LEAD, please visit and fill out the Admissions Airport Transportation form. We will not be able to provide shuttle service if you contact us after January 6, 2017.
Please note: shuttles are only provided from the Dayton or Columbus airport.

T-shirt Order

Payment Information

Total Amount: $