2011 Fall Session Registration

Submitted by Jen Gross on Fri, 2011-08-05 14:12

Please fill this out prior to October 24, 2011. Submission of your registration signifies agreement with the Senate's cancellation policy.

First Name: *

How you'd like it printed on your name badge.

Last Name: *

College or Organization: *

Senate Position:

If left blank, what is entered in the Discipline/Title field will be printed on your badge.

Discipline or Title:

Please enter your discipline or title.

Home Mailing Address:

Will not be published. Please provide street, city, state and zip.

Phone Number:

(999)555-5555

Email: *

Area Designation: *

Registration Type: *

Hotel room is not included in the registration fee. Please call the hotel directly.

Please describe any special requests:

I would like to request a scholarship.:

Yes

Please check is box for financial assistance. Then send an email describing your needs to events@asccc.org. (Available for local senate delegates only.)

By submitting this form, you accept the Mollom privacy policy.

2011 Fall Session Registration

Quick Links