*This form must be turned in to your local CLT coordinator by the deadline (usually two months before CLT – sometimes earlier).*

 Please complete the following:

 I. Registration Information

Name __________________ Campus ____________ Area __________

 Campus Address ____________________________________________

 City _________________ State ________ Zip ______ Phone (___)_____

 II. Previous Experience

 Please indicate on the following scales the amount of previous experience you have in:

                                                                                          None                              Much

 meeting with professors to line up classroom lectures              1    2    3    4    5    6    7

presenting Christian lectures  to university classrooms              1   2    3    4    5    6    7

III. Resume Information

 A. Education (university, degrees, major): _________________________

___________________________________________________________

 B. Years on staff: __________ Present position: ____________________

 C. Other related information (honors, speaking experience, IBS, etc.):

__________________________________________________________

___________________________________________________________

 IV. Lecture Topic (design title and description to appeal to a professor)

 A. The title of my lecture is: _____________________________________

 B. A brief two-to-three sentence description of my lecture is: ___________

___________________________________________________________

___________________________________________________________

 Note: please do not change your topic after you have turned in this registration form.

 V. Commitments

 A. Experience has shown us that, to help staff gain the most from CLT, all involved must make the following commitments:

     1. Prepare a 30 to 35 minute lecture before the CLT week.

     2. Give the lecture in a class during the CLT week.

     3. Remain on location and be involved during the entire week

        (usually Sunday afternoon to 5 p.m. Friday).

     4. Follow through by speaking in at least one class per quarter

        for the remainder of the year.

 B. You may have made these four commitments on your own or your director may have made them for you. In any case, we ask that you sign the statement below as an indication that you are aware of the commitments being made. We do this merely as a double check to be sure that everyone understands now and to help prevent confusion later. Thanks for your cooperation!

 C. (Please sign.) "I understand that I am committing myself (or my

director is committing me) to make the four CLT commitments and to prepare the lecture I listed in Part III above before CLT begins."

 Signature: _______________________________________

 VI. Deadline for Form

 This completed form must be in the hands of the local CLT coordinator by the assigned deadline (two months or more before the start of CLT). He must have it by then in order for you to participate in CLT. Find out the following information from your CLT coordinator:

 A. The coordinator for our CLT is:

 Name_________________________ Phone (___) __________________

 Address _______________________

 City _____________________ State _______________ Zip ___________

 B. The due date for this form is _________________________________ .