Career Day Conference

Registration Form

Registration fee:  $100  ($50  for each additional person)              

Office of Placement Services,
1000 ASU Drive 540,
Alcorn State, MS  39096-7500
*please check one : Dr. Mr. Mrs. Ms.
*NAME :           
  first name                    middle initial      last name
*TITLE :
   
*COMPANY :
   
*ADDRESS1 :
ADDRESS2 :
   
*CITY :    *STATE :        *ZIP :
   
TELEPHONE :                     E-MAIL :
   
FAX NUMBER :  

I will participate

I will not participate

Mail the check  made payable to the ASU Office of Placement Services

 Will pay fee on site
   

I will bring an exhibit

Will donate door prize's

I will need an electrical outlet

Special dietary needs
Comments :

Please select below your first, second, third and fourth areas of preference for  your class visits.

First Preference
Second Preference
Third Preference
Fourth Preference

List the additional persons coming with you, Separated with a comma( , )