Registration closes November 2, 2012. On-site registration will be accepted, if space permits.
E-mail :
Phone :
Major:
This conference includes breakfast & lunch. Please list any dietary restriction and we will do our best to accommodate. Thank You
Student Organization Membership: (If Any) and Offices Held (If Any)
By submitting this registration, I commit to attending this conference and experiencing it to the Fullest!
You can also print out this form and bring it to the Office of Campus Activities 235 CCSU
