Attendee Information |
| Name: |
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| School: |
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Student Organization
or Department: |
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| Contact Person: |
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| Position: |
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| E-mail: |
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| Phone: |
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| Number of Students Attending: |
$25 per ticket |
| Number of Non-Student Attending: |
$25 per ticket |
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Which categories are you selecting?
(Press the CTRL key
to select more than one) |
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Please specify any
dietary restrictions: |
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Personal Information for Credit Card Transaction |
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* indicated required fields
Provide information as seen on the card. |
| *First Name: |
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| *Last Name: |
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| *Home Address: |
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| *City: |
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| *State: |
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| *Zip: |
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| *Phone: |
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| *E-mail Address: |
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| Total Amount: |
$ |
| |
| Notes or Questions: |
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For more information contact
Intercultural and International Center
Northwest Missouri State University
Union 2060
Maryville, MO 64468
Phone: 660.562.1517
Fax: 660.562.1546
Email: lambert@nwmissouri.edu |