Registration Form

I am registering as a:
Name:
Street:
City:
State:
Zip:
Home Phone:
Work Phone:
Email:
College Major:
Race/Ethnicity:
I understand the importance of the three networking meetings and I commit to attending them Yes

An exception will be made ONLY for students who will be away for a project during one term.

In what cluster would you like to be placed? (Please note that like clusters may be combined.)
Other:
If appropriate, please select your second choice cluster (we make every attempt to place students in their first choice, it is sometimes necessary to place professionals in their second choice to provide all students with access to professionals)
Students: What term(s), if any, do you plan to be away during the 2008-2009 year? Term A
Term B
Term C
Term D
Term E

Professionals Only Section

Current title:
Current company:
College(s) attended:
At the end of the year, we would like to provide your supervisor with a letter commending your participation in the Dine Out Program. If we may do so, please provide your supervisor's contact information:
Name
Title
Company
Address Line 1
Address Line 2
City
State
Zip
Type in the following two words
 
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Last modified: October 09, 2008 11:19:49