UniTech Attendee Form

The University Technology Summit

Thank you for your interest in the University Technology Summit, being online, Febriary 22-24, 2021. It's a unique experience that you're sure to find incredibly rewarding.To be considered for one of the limited discussion seats, please complete the application below. Should you have any questions, please feel free to contact Michael Gallo, Chairman, at 917.502.0139 or mgallo@gbmsummits.com

First Name	*
Last Name	*
Title	*
Department
Institution	*
My institution is:	*
Total Enrollment (Estimated)	*
Total Undergraduate Enrollment (Est.)	*
Email Address	*
Phone Number	*
Cell Number	*

Address	*

City	*
State / Province	*
Zip / Postal	*

Please tell us a little about yourself. Your background, how you rose through the ranks to this position, and anything that you'd like others to know about you:	*
Tell us about what you're doing well / what's going well from a technology perspective at your institution:	*
Next, describe a few of the most pressing challenges you're experiencing. If you were in a room full of those who do exactly what you do, what would you want to uncover and talk about?	*
Please tell us about any technology products or services you're interested in learning about over the next six to 12 months:	*
Is there someone else who you think we should invite to be part of the group? If so, please list them here: Name, Title, & Organization. Phone and/or e-mail are also helpful.
Non-Profit Organization: Should you join the Summit and participate in all assigned functions, the Summit will donate $250 to the following organization on your behalf. Please note if there's a specific chapter:
If I participate the Online Summit, I agree to be present for all discussions, meetings and networking functions. The Summit's donation will only be provided to my organization if this requirement is met.	*	I do