Participant Information Form

This form must be completed prior to April 10th to ensure you are able to register for classes April 12-14, 2017.
Only continue with this form if your participant space for the 2017 Annual Leadership & Training Seminar has already been paid for by your organization and your organization has received confirmation from the AWAG Treasurer. If you want to confirm if you have been sponsored by an organization - please email Alexa Mattil at registration@awagleadership.org.

Thank you!

* Indicates required field

Name *

Contact Email *

Contact Phone Number *

Sponsoring Organization *

Emergency Contact Name *

Emergency Contact Phone (please include area code) *

I have requested and paid for a single supplement. *

Yes No

I am a *

Female Male

Please pick a roommate for me. *

Yes No

If No, Name of Requested Roommate *

I have a valid DOD ID card. *

I am a prior AWAG Board of Governors member. *

I am currently serving as a *

I am / my spouse is currently serving as an O-5 or O-6 in command or their enlisted E-9 counterpart. *

Optional Demographic Questions:

I am a *

Age Range *

Military Branch *

How did you hear about us? *

I am replacing a participant from my organization that previously signed up. *

Yes No

If yes, please enter participant name here: *

Special/ Medical/ Dietary Needs *

Additional Comments *

PHOTO RELEASE STATEMENT: I hereby grant AWAG permission to use my likeness in a photograph in promotional material, on the AWAG website and in social media maintained by the organization without payment or any other consideration. This voluntary grant and release will not be made the basis of a future claim of any kind against AWAG, United States Government and its agents, officers, servants, and employees when acting in their official capacities; and to persons, firms or corporations contracting with the United States Government, and their heirs, executors, administrators, successors, or assigns; and to any other persons lawfully reproducing, distributing, exhibiting, or otherwise using the said production or any portion thereof.

Please review the information below. If correct, please click the Register button to complete your registration.

Complete Registration