LAI EdNet Summer Workshop Registration

First Name

Last Name

Title

Organization

Address1

Address2

City

State

Zip

Preferred Telephone #

(555-555-5555)

We would be happy to host your spouse / significant other during your visit. Please let us know the name of your guest(s) below:

Name

Please list any food allergies or dietary restrictions for attendees – we’ll gladly accommodate your requests:

Please provide the following information to allow us to plan appropriate space and other logistic support by indicating which events you are planning on attending (please enter the number of expected attendees):

Event

# of attendees

Monday BBQ lunch

Monday afternoon committee meetings

Monday dinner with Dr. Deanna Willis

Tuesday evening outing @ Nine Irish Brothers

Wednesday afternoon plant tour @ Caterpillar’s Lafayette Engine Center

Thursday morning plant tour @Subaru of Indiana Automotive

To assist in our pre-planning efforts for the Tuesday and Wednesday working sessions, please indicate rank your preferences for the sessions. Your selections are not binding; we will use these for guide expected session outcomes and for logistic support.

Please note:
1. A minimum one session must be selected
2. The rank value must be different for each session

	1	2	3	4
Lean Engineering and Product Development
Lean Healthcare and Curriculum Developmen
Operational Excellence
VSM Curriculum Development