Fall 2017 Graduate and Professionals Schools Day Registration Form

Registration Form

Question Title

* Contact Information

School Name

Programs

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

* Fax Number

Question Title

* Web Address

Question Title

* Please provide information below for all representatives who will attend

Name

Title

Alumni/Graduation Year

Name

Title

Alumni/Graduation Year

Name

Title

Alumni/Graduation Year

$150.00 Non-Refundable Registration Fee (3 Representatives)
$25 for Each Additional Representative

Question Title

* Check Will Follow (Make payable to Mississippi Valley State University)

Yes

Question Title

* Credit Card Information (MasterCard, Visa, Discover & American Express accepted)

Name on Card

Credit Card #

Expiration Date (Month/Year)

Security Code (CVV2#)

Question Title

* Representative Display Booth Information

School Name

Program(s)

Representative(s) will be provided with a display booth containing the following:

·        Six-foot Table

·        Chairs (2)

·        Table Linen

Please indicate if you will need any additional chairs or electricity below:

Question Title

* Number of Additional Chairs

Question Title

* Electricity?

Question Title

* Indicate additional accommodations or requests below:

Please complete and submit by Friday, September 08, 2017

Mississippi Valley State University

Career Services Center

MVSU 7225

14000 Hwy 82 West

Itta Bena, MS 38941-14000

Phone: (662) 254-3441

Fax: (662) 254-7065

Email: careerservices@mvsu.edu