CMSS GLEAM 2025 Registration Form

Participant 1 Details
Participant 1 Name*

First NameLast NameSuffix
Participant 1 Email*
example@example.com
Participant 1 Phone Number
Please enter a valid phone number.
Assistant Name

First NameLast Name
Assistant Email
example@example.com
Participant's Society Leadership Role (by category)*

CEO/Executive DirectorBoard Chair/PresidentBoard Chair-Elect/President-ElectPast PresidentOther Volunteer LeaderSociety Staff MemberOther
Are you registering another participant?*

YesNo

Participant 2 Details
Participant 2 Name*

First NameLast NameSuffix
Participant 2 Email*
example@example.com
Participant 2 Phone Number
Please enter a valid phone number.
Assistant Name

First NameLast Name
Assistant Email
example@example.com
Participant's Society Leadership Role (by category)*

CEO/Executive DirectorBoard Chair/PresidentBoard Chair-Elect/President-ElectPast PresidentOther Volunteer LeaderSociety Staff MemberOther
Are you registering another participant?*

YesNo

Participant 3 Details
Participant 3 Name*

First NameLast NameSuffix
Participant 3 Email*
example@example.com
Participant 3 Phone Number
Please enter a valid phone number.
Assistant Name

First NameLast Name
Assistant Email
example@example.com
Participant's Society Leadership Role (by category)*

CEO/Executive DirectorBoard Chair/PresidentBoard Chair-Elect/President-ElectPast PresidentOther Volunteer LeaderSociety Staff MemberOther
Are you registering another participant?*

YesNo

Participant 4 Details
Participant 4 Name*

First NameLast NameSuffix
Participant 4 Email*
example@example.com
Participant 4 Phone Number
Please enter a valid phone number.
Assistant Name

First NameLast Name
Assistant Email
example@example.com
Participant's Society Leadership Role (by category)*

CEO/Executive DirectorBoard Chair/PresidentBoard Chair-Elect/President-ElectPast PresidentOther Volunteer LeaderSociety Staff MemberOther
Are you registering another participant?*

YesNo

Participant 5 Details
Participant 5 Name*

First NameLast NameSuffix
Participant 5 Email*
example@example.com
Participant 5 Phone Number
Please enter a valid phone number.
Assistant Name

First NameLast Name
Assistant Email
example@example.com
Participant's Society Leadership Role (by category)*

CEO/Executive DirectorBoard Chair/PresidentBoard Chair-Elect/President-ElectPast PresidentOther Volunteer LeaderSociety Staff MemberOther
Are you registering another participant?*

YesNo

Participant 6 Details
Participant 6 Name*

First NameLast NameSuffix
Participant 6 Email*
example@example.com
Participant 6 Phone Number
Please enter a valid phone number.
Assistant Name

First NameLast Name
Assistant Email
example@example.com
Participant's Society Leadership Role (by category)*

CEO/Executive DirectorBoard Chair/PresidentBoard Chair-Elect/President-ElectPast PresidentOther Volunteer LeaderSociety Staff MemberOther
To register more than six (6) people for GLEAM 2025, please contact Shaniece Rigans at srigans@cmss.org.

CMSS GLEAM Program Registration Form