SLA New England Day on the Job 2012 Host Sign Up Survey

Please enter your contact information. Each field must be completed.(Required.)

First name:

Last name:

Organization:

Address:

City:

State:

Zip:

Phone:

E-mail:

Accessible by public transportation?(Required.)

Yes

No

Number of students you can host.
(Can be simultaneously or separately)(Required.)

1

2

3

4

Are you a member of SLA?
Note: SLA membership is not a requirement for participation in the "Day on the Job" program.

Yes

No

Please add any comments or questions here:(Required.)

Thank you for supporting this program.
To complete registration form, please click the NEXT button.