Registration Form

Please use the following information to coordinate all event details:

Participant’s Name: ________________________________________________

Company Name or Affiliation: ________________________________________

Phone: _______________________________________________________

Email: ________________________________________________________

Address: ______________________________________________________

City: _____________________________ State: _________ Zip:________

Dietary Needs: (vegetarian, vegan, etc.) _____________________

Registration Fee: $100

Student Fee: $50

I am interested in registering for a booth at the NC State Minority Career Fair (please see http://www.ncsu.edu/mcf/ for details, pricing, and registration for the fair).  Discounted registration for MCF available to Diversity Summit participants.

___Yes

___No

Mail invoice to this address and have Check made payable to:

Community for Diversity in Natural Resources.

NC State University, CB 8001, Raleigh, NC 27695

Memo: Cultivating Resources

Credit Card

 Visa  MasterCard

 ________________________________________ Card Number   

________  Expiration Date

Sponsorship opportunities offered through the Community for Diversity in Natural Resources. For additional information, contact Thomas Easley at Thomas_Easley@ncsu.edu or 919-513-0534.

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