Annual Leadership Ceremony Registration

May 2nd, 2012 at 5:00pm

Bedford Campus Center, Cafeteria

 

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1. Please type your full name.
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2. Please type your email address.
3. If you will have any non-student guests joining you, please indicate their names below (maximum of 3).
4. Please list your respective club(s) or organization(s) of which you are a member.
5. Dietary restrictions:
6. Will you or a guest require special accommodations:
For more information, please contact Debbie Jordan at 781-280-3762 or jordand@middlesex.mass.edu.

We look forward to seeing you at the 2012 Leadership Recognition Ceremony on May 2nd at 5pm in the Bedford Campus Center, Cafeteria.

Thank you

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