HBCU registration form 2011 2012 5 mkts no rates by JdaU3Rk4


									                                          HBCU 2011-2012
                                     College Registration Form

Instructions: Please complete this form and check all the venues you would like to attend. To enter your information,
simply TAB to each field and begin typing, email your completed form to diana@thecollegeexpo.org or fax a copy to
909-396-0932. If you have questions, please contact Diana at 909-396-0151 or 877-427-4100.
   Saturday, October 22nd, 2011 – York College/CUNY (Queens) Jamaica, NY
   Saturday, November 12th, 2011 – DC/Maryland-University of Maryland, College Park
   Saturday, January 28th, 2012 – Los Angeles-Los Angeles Convention Center
   Saturday, February 11th, 2012 - Atlanta-Cobb Galleria Centre
   Saturday, February 18th, 2012 – Oakland-Oakland Marriott Convention Center
Call in for booth rates:

Participating College:


Admission/Recruitment Representative:

Phone:                                         Fax:                           E-mail:

College Areas of Academic Specialty:

Years of Participation in the Black College Expo:

Alumni Representative:

Address:                                                                      E-mail:

Phone:                                             Fax:                                      Cell:

                  *If you would like to purchase an ad in program book check here
The following items are included with your registration:
1 – 10 x 10 Booth             4 - Volunteer Booth Passes
1 – Draped Table               - Private Hospitality Area
2 – Folding Chairs             - Free Listing Booklet
1 – Identification Sign
1 – Waste Basket               Items Not Included: Internet Access, Shipping Services and Electrical

    Accepting applications on site                                     Application fee will be waived

*Please make check or money order payable to NCR
Foundation and remit payment with registration form to:                    *Credit Cards accepted
                                                                           Amex      Discover   MasterCard     Visa
NCR Foundation c/o Black College Expo                                      Card #:
750 N. Diamond Bar Blvd., Suite 208                                        Exp. Date          Security Code:
Diamond Bar, CA 91765
www.thecollegeexpo.org                                              Name on credit card:

*Payments are non-refundable.                                       Signature: ________________________________________

Modified 9/7/10

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