Leadership KA Application For more information please contact Brent Fellows, Assistant Executive Director for Alumni Affairs at (540) 463-1865 or bfellows@ka-order.org. Step 1 of 2 - Step 1 50% Name* First Middle Last Suffix Preferred First Name for Name Tag* Initiated Chapter Year Initiated College/University Email Address* Date of Birth* MM slash DD slash YYYY Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Cell Phone*Work Phone Provide a brief statement of the reason (s) you wish to participate and what you expect to gain in Leadership KA:Biography (Professional, KA & Personal)Upload Headshot*Max. file size: 50 MB.Travel InformationSelect Day of Arrival*I prefer to arrive Thursday to audit the NLI conferenceFriday only to attend Leadership KAIf selected, would you be*Flying (live more than 4 hours from Greensboro, NC)Driving (Live within 4 hours of Greensboro, NCIf flying, note closest major airport If driving, note roundtrip mileage to 4756 Caraway Mountain Road, Sophia, NC, 27350 If selected as a participant in Leadership KA, I agree to attend all functions sponsored by the program. I understand that if I fail meet this obligation of the program, I may be asked to withdraw and pay the full costs associated with the program.* I agree to the Leadership KA Policy PhoneThis field is for validation purposes and should be left unchanged.
