Urban Music Leadership Conference 2012 - Saint Louis, MO
October 25-27, 2012
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UMLC Registration Form

 Only registered attendees may participate in conference activities.

Please print and complete the form below and mail with $75.00 registration fee to:

Dr. Robert Crisp, Treasurer

17596 Oak Dr.

Detroit, MI  48221

Please make checks payable to Urban Music Leadership Conference. 

Sorry, UMLC does not accept Credit Cards or Purchase Orders.

Participant Information

First Name:___________________________________

Last Name:___________________________________

Title:________________________________________

Home Address:________________________________

City, State, Zip:________________________________

Home Phone:__________________________________

School District:________________________________

School Street Address:__________________________

City, State, Zip:________________________________

School Phone:_________________________________

School E-Mail:_________________________________

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