2011 Participant Information Form
Please email the completed form to Cindy Weber @ firstname.lastname@example.org. In addition, please
submit your photograph as a digital image attached to an email.
Please complete the following NELD Participant Information and return by November 19, 2010.
Dietary Restrictions? Yes No
If yes, explain:
International Travel Information:
(If you prefer to give this information via phone, please contact Cindy Weber @ 507-389-6975)
Name as it Appears on Passport
Date of Birth
Biographical Sketch: Please describe your work experience, your present responsibilities, and
any personal information you would like to share (150 word max).
To paste text into box, use ‘Control V’