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Omicron Delta Kappa

The National Leadership Honor Society

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Circle Advisor Training Workshop Registration

1Circle Information

2Pandemic Event Protocol

3Personal Information

4Professional Information

5Demographic Information

6Terms and Conditions

7Review and Submit Form

Advisor Role *

Circle Coordinator
Faculty Advisor
Alumni Advisor
Circle Assistant

Circle you are advising *

How Long have you advised this circle? *

1 year or less
1-3 years
4-6 years
6 years or more

Institution of Initiation *

Please use the full name (e.g., Washington and Lee University). For Sponsors, please insert your company

Year of Initiation *

(YYYY) If you are unsure of your initiation year, please guess.

Pandemic Event Protocol

Due to the recent identification of a new variant of SARS-COVID-19, we continue to assess the risks in the area local to the event and the current status in the United States. In keeping with the Society’s duty of care and the responsibility as host, O∆K has implemented safety requirements for the Circle Advisors Training Workshop. Please read the safety protocols at this link https://ek63gckf9hv.exactdn.com/wp-content/uploads/2021/12/pandemicprotocolfy2022.pdf before answering the item below.

Vaccination/COVID Test Status *

I attest that I am or will be fully vaccinated by January 7, 2022
I will have a COVID-19 PCR test with 72 hours of arrival in Alexandria, Va. For the workshop.
I choose not to be vaccinated nor tested

Choose one.

Name *

First

Middle

Last

Previous or Maiden Name

Email *

Mobile Phone *

Employment Address *

Address Line 1

Address Line 2

City

State

Zip Code

If you are an Alumni Advisor and retired or not employed, please enter your personal address information.

Current Professional Title

Current Business, Institution, or Organization Name

Social Media

We encourage you to list your LinkedIn information so we can connect with you on that platform.

LinkedIn

Personal Pronouns

If you would like for the attendees to use specific pronouns for your information, please complete this section.

What are your pronouns?

He/Him/His
She/Her/Hers
They/Them/Their
Ze/Zim/Zir
Prefer Not to Answer
Not listed

Do you wish O∆K to publish your pronouns with your name in registrant listing?

Yes
No

Dietary Restrictions *

Please provide details of any dietary restrictions. We will work with the hotel to the best of our ability to meet your needs. If you have no restrictions, enter "none"

Travel Grants *

I will not need a travel grant
I may need a travel grant
I will definitely need a travel grant

O∆K is prepared to offer a travel grant of up to $250 for officers who have no insittutional support to attend. These grants are limited and on a first come, first served basis.

Travel Grant Explanation *

Travel grants are provided as a reimbursement. Please provide an explanation of why you need financial assistance for travel. Each circle is limited to a maximum of $250.

Demographic Data

The information gathered in this section is gathered for statistical purposes only. This information is only being used to gather data about members attending our events and will not be placed in your permanent O∆K record. Completion of any of these inquiries or this whole portion of the registration form is not required; however, it is helpful information to inform future discussions about the Society’s diversity, equity, and inclusivity initiatives. https://odk.org/omicron-delta-kappas-commitment-diversity-inclusion/

What is your age range?

20 or under
21-24
25-34
35-44
45-54
55-64
65 or older

Do you consider yourself biracial or multiracial?

No, Not Biracial or Multiracial
Yes, Biracial
Yes, Multiracial

Select one.

Are you of Hispanic, Latino, or Spanish origin?

Yes, Hispanic or Latino
No, Not Hispanic or Latino

One or more may be selected.

What is your racial identity? One or more categories may be selected.

American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander
White
Not Listed

One or more categories may be selected. For specific information on these racial identity groupings, go to https://odk.org/dei-demographics

What is your gender identity?

Man
Woman
Genderqueer
Non-binary
Transgender
Non-Binary
Not Listed

Select the option that best describes you.

What is your Sexual Orientation?

Heterosexual
Asexual
Bisexual
Demisexual
Gay
Lesbian
Pansexual
Not Listed

Select the option that best describes you.

Late Cancellation/No Show Policy *

I agree

I have read and understood the refund policies posted on the O∆K website: [NAME] and agree with these terms.

PHOTO RELEASE AGREEMENT *

I agree

By my registration and attendance at the Circle Advisor Training Workshop. I grant to Omicron Delta Kappa, its representatives, and employees the right to take photographs of me and my property in connection with the above-identified subject. I authorize Omicron Delta Kappa, its assigns, and transferees to use photographs or images provided by me in connection with the above-identified subject. I authorize Omicron Delta Kappa, its assigns, and transferees to copyright, use, and publish the same in print and/or electronically. I agree that Omicron Delta Kappa may use such photographs of me with or without my name and for any lawful purpose, including for such purposes as publicity, illustration, advertising, and web content.

Updating preview…

This is a preview of your submission. It has not been submitted yet!
Please take a moment to verify your information. You can also go back to make changes.
I have have chosen not to be vaccinated or tested, a member of the O∆K staff will contact but you will not be registered at this time.

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