2012 SEPTA College Fair Registration
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P'ville SEPTA
*
1
. Will you be attending the October 3rd "Colleges w/a Difference" Fair?
Will you be attending the October 3rd "Colleges w/a Difference" Fair?
Yes
No
*
2
. Please provide the your name and that of the program you represent:
Please provide the your name and that of the program you represent:
Name:
Program:
Address:
Address 2:
City/Town:
State:
-- select state --
AL Alabama
AK Alaska
AS American Samoa
AZ Arizona
AR Arkansas
CA California
CO Colorado
CT Connecticut
DE Delaware
DC District of Columbia
FM Federated States of Micronesia
FL Florida
GA Georgia
GU Guam
HI Hawaii
ID Idaho
IL Illinois
IN Indiana
IA Iowa
KS Kansas
KY Kentucky
LA Louisiana
ME Maine
MH Marshall Islands
MD Maryland
MA Massachusetts
MI Michigan
MN Minnesota
MS Mississippi
MO Missouri
MT Montana
NE Nebraska
NV Nevada
NH New Hampshire
NJ New Jersey
NM New Mexico
NY New York
NC North Carolina
ND North Dakota
MP Northern Mariana Islands
OH Ohio
OK Oklahoma
OR Oregon
PW Palau
PA Pennsylvania
PR Puerto Rico
RI Rhode Island
SC South Carolina
SD South Dakota
TN Tennessee
TX Texas
UT Utah
VT Vermont
VI Virgin Islands
VA Virginia
WA Washington
WV West Virginia
WI Wisconsin
WY Wyoming
ZIP:
Country:
Email Address:
Phone Number:
3
. What is the best way for us to contact you-please be specific?
What is the best way for us to contact you-please be specific?
4
. What student population does your program best serve?
What student population does your program best serve?
5
. Do you require any reasonable accommodations in order to participate in this event?
Do you require any reasonable accommodations in order to participate in this event?
6
. Although there is NO CHARGE for this event, the Pleasantville SEPTA is a 501c3 non-profit and gratefully accepts donations: http://pvillesepta.com/15.html
Although there is NO CHARGE for this event, the Pleasantville SEPTA is a 501c3 non-profit and gratefully accepts donations: http://pvillesepta.com/15.html
7
. Thank you so much for your response! Do you have any questions or require any additional information?
Thank you so much for your response! Do you have any questions or require any additional information?
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