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Impact Retreat 2012

PLEASE NOTE: At this point you are being put on a wait list for 2012 IMPACT Retreat. You will be notified by email if a spot becomes available.

1. First Name*
2. Last Name*
3. Student ID Number*
4. Address*
5. City*
6. State*
7. Zip Code*
8. Phone Number*
9. E-mail Address*
10. E-mail Address (please re-enter)*
11. Gender*
M    F   
12. T-shirt Size*
13. Orientation Session You Are Attending*
14. If you have any medical conditions or are taking any medications that we should be aware of, please explain here
15. If you have any special dietary needs (vegetarian, etc.) please explain here
16. Please tell us how you will be arriving on campus to leave for Impact.*
My parents are bringing me
I am driving myself
17. If other, please indicate how you will be arriving. If flying, please send flight info to so we can arrange to pick you up
18. If you are driving to Warrensburg for Impact, would you like us to share your contact information with other freshmen in your area so you can coordinate car pools? If you select yes, we will release your contact information to other Impact participants in your area*
Yes    No   
19. Do you need accommodations in Warrensburg on Tuesday, July 24, prior to our departure for IMPACT on Wednesday, July 25, and/or Friday, July 27 when we return? (Note: students will be staying in a designated Hall on campus. The cost will be $10 per night but students must bring their own linens.)**
No    Yes, just on Tuesday night    Yes, just on Friday night    Yes for both nights   

We will be departing for the retreat at approximately 10 a.m. on Wednesday and returning to campus by 2:30 p.m. on Friday.

20. Please tell us at least one thing you are hoping to gain by attending the Impact Retreat

Payment Information:
$75 will be charged to your student account or make check payable to UCM which can be mailed to Office of Student Activities, IMPACT Retreat, Union 217, Warrensburg, MO 64093.