WAEOPP

Registrant Information
First Name
Last Name
Title

Select One:  WAEOPP   Member   Non-Member

Check All that Apply:

EOC	ETS	UB	UBMS
SSS	EOP	UBVet	McNair
Other	GearUp	Precollege

Your Start Date with TRIO (include month/year at least)

Mailing Address
Institution Name
Street
Street Line Two (NOT Required)
City
State
Zip Code
Phone (include area code)   Example: 555-555-5555 please include the dashes
Fax (include area code)

E-Mail and Website
E-Mail Address
Second E-Mail Address
Program Website

Days and Meals
Check all that you will attend -- Tickets will be required for all meals

NOTE: Meals are the biggest cost to the conference, checking only the meals you will attend
will allow the planning committee to maximize the revenue after expenses associated with the spring professional conference.

Yes   No   Presidents Banquet, Wednesday, April 22

Yes   No   Breakfast, Thursday, April 23

Yes   No   Lunch, Thursday, April 23

Yes   No   TRiO Achievers Dinner, Thursday, April 23

Yes   No   Breakfast, Friday, April 24

Special Dietary Needs.