UMBC Student Affairs
Assessment Day 2010 Registration Form

Questions marked with an asterisk (*) are mandatory.
1

* First Name
2

* Last Name
3

* email address
4

Mailing Address

Name:
Company:
Address:
City: State: Zip:
5

* Registration Type and Fee:

UMBC Student Affairs-$0
UMBC Faculty and Staff-$0
UMBC Student-$0
MCPA Member- $10
All Others-$25
6

* Would you like to purchase a lunch ticket?  In response to tight budgets we are offering registration with or without lunch.

A continental breakfast will be provided for all attendees. Lunch will be provided only for those who purchase a lunch ticket.  You are free to bring your own lunch if you wish.

I do not wish to purchase a lunch ticket. I will do lunch on my own.
UMBC Student Affairs-$0
UMBC Faculty and Staff-$20
UMBC Student-$20
MCPA Member- $20
All Others-$20
7

* Total Registration Fee Due (Registration + Lunch) :

$0
$20
$30
$45
8

Accomodations needed:

Please mail a check made out to UMBC to:

Assessment Day
c/o Dr. Susan Martin
UMBC
VP of Student Affairs Office, Commons 319
1000 Hilltop Circle
Baltimore, MD 21250

This information will also be on the page that appears after you hit submit.