Fall 2025 BCLS Seat Request Form

CONTACT INFORMATION

District Name*

School Name

If you are registering as an individual school, please enter your school's name here.

Superintendent Name*

Superintendent Email*

Contact Name*

Contact Email*

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

REQUESTED SEATS

Base Camp Dates: Sept. 24-26, 2025 Leadership Summit Dates: Nov. 12-14, 2025

The estimated value of each seat is $3,500. GLISI awards a per-seat credit of $600, making the price of attendance $2,900 per participant.

# Seats *

Enter the number of cohort seats requested (minimum of 5) in # Seats.

Price: $2,900.00

Please provide contact information for invoicing in the spaces below.

INVOICING

Invoicing Contact Name*

First Last

Invoicing Contact Email*

Invoicing Contact Phone*

Preferred method of invoicing*

Invoice upon confirmation of registration
Invoice after July 1

Statement of Financial Hardship*

If the registration fee will prevent you from attending, please use this space to provide a brief narrative explaining your financial hardship. Additional scholarship assistance may be available. Priority for financial assistance will be given to registrations received by May 16, 2025.

STRATEGIC ALIGNMENT

Please provide a brief overview of how attending Base Camp and Leadership Summit aligns with your improvement plan.*

What outreach methods influenced your registration?*

Select all that apply:

Brochure or Postcard
Outreach from GLISI Staff
Facebook
Twitter
Website
Colleague Referral
Other

Please provide a brief explanation*

CANCELLATION POLICY

GLISI will acknowledge your reservation upon receipt of this form and will confirm registration pending seat availability. GLISI will invoice upon confirmation. All invoices are due within 30 days of invoice date. Registrations are only valid for the Fall 2025 cohort. Cancellations, reductions in team size, or requests to adjust invoice terms are not guaranteed and should be made in writing by May 16, 2025 with a request to Jennie Welch at [email protected].

SUPERINTENDENT AUTHORIZATION

Check the box below to verify that the Superintendent has reviewed and agreed.*

The Superintendent has read the cancellation policy above.

REGISTRATION

2025 Fall BCLS Seat Request Form

2025 Fall Base Camp and Leadership Summit: Seat Request Form