Graduate and Professional Schools Information Day

 

 

Registration Form

Office of Placement Services,
1000 ASU Drive 540,
Alcorn State, MS  39096-7500

Registration fee:  $75  ( $35 for each additional person)
*please check one : Dr. Mr. Mrs. Ms.
*NAME :             
  first name                   middle initial        last name
*TITLE :
   
*COLLEGE/UNIVERSITY :
   
*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

Need an electric outlet

Special dietary needs :

    Comments :

  

List the additional person's coming with you! Separated with a comma( , )