Organization
Name:
Contact Person/Title:
Email:
Address:
City:
State:
Zip:
Phone:
Fax:
Representative Attending (Name & Title):
Rep. Email:
Representative Attending (Name & Title):
Rep. Email:
-SPECIAL REQUESTS-
Electrical Access
Extra Chairs (in addition to the 6-ft table and 2 chairs provided)
Lunch will be provided for two representatives. Additional meals may be purchased in the Mustang Dining Hall.
For Miscellaneous Requests
Registration Fee - $40.00
Phone: (575) 538-6109 Fax: (575) 538-6265
Email: leckm@wnmu.edu