Leadership Academy Membership Form

Register for Membership: 2025–2026

Comprehensive membership dues are $475 for the 2025-2026 year. This membership includes attendance for multiple people. If you are registering more than eight people, please contact Mykia Brown for assistance (mybrown@monmouth.edu).

Select Your Membership Level

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Membership Season

Membership Selection(Required)

Please select your membership level

Leadership Academy

Monmouth University Student/Faculty

Membership Dues Cost:

Registrant Information

Please provide accurate contact information for the person completing this membership form. If applicable, the registrant will receive an invoice via email and will be the main contact for any billing inquiries (unless you specify otherwise).

Name(Required)

First Last

Title(Required)

Email(Required)

Phone(Required)

Is the registrant the best person to contact for any invoices, inquiries, or updates?(Required)

Yes

Best Contact's Name(Required)

First Last

Best Contact's Title(Required)

School Information

School District(Required)

County(Required)

Address(Required)

Street Address City State ZIP Code

Attendee Information

How many people will attend the academy?(Required)

Please enter a number from 1 to 8.

Title(Required)

Attendee Name(Required)

First Last

Title(Required)

Attendee Name(Required)

First Last

Title(Required)

Attendee Name(Required)

First Last

Title(Required)

Attendee Name(Required)

First Last

Title(Required)

Attendee Name(Required)

First Last

Title(Required)

Payment Information

Total Amount Due

Is Your Purchase Number Available?(Required)

Yes

Comments

This field is for validation purposes and should be left unchanged.

Register for Membership: 2025–2026

Select Your Membership Level

Registrant Information

School Information

Attendee Information

Attendee #1

Attendee #2

Attendee #3

Attendee #4

Attendee #5

Attendee #6

Attendee #7

Attendee #8

Payment Information