Fall 2019 Graduate and Professionals Schools Day Registration Form

Registration Form

Question Title

* 1. Contact Information

School Name

Programs

Address

City/Town

State/Province

ZIP/Postal Code

Contact Name

Email Address

Phone Number

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* 2. Fax Number

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* 3. Web Address

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* 4. 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 (2 Representatives)
$25 for Each Additional Representative

Question Title

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

Yes

Question Title

* 6. Credit Card Information (MasterCard, Visa, Discover & American Express accepted---Please note: All credit card transactions are subject to a 4% processing fee and will be added to your total charge.)

Name on Card

Credit Card #

Expiration Date (Month/Year)

Security Code (CVV2#)

Question Title

* 7. 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:

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* 8. Number of Additional Chairs

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* 9. Electricity?

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* 10. Indicate additional accommodations or requests below:

Please complete and submit by Friday, August 30, 2019

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