Annual Graduate and Professional School Form

Prefix

First Name *

Last Name *

Title

College\University *

Street Address

City

State

Zip Code

Telephone Number *

Fax Number

Email *

Targeted Disciplines *

Special dietary needs

List any additional representatives that are planning to attend the Fair:

Will You Require One of the Following:

Electrical Outlet

Wireless Access

If paying by credit card, please contact Ms. Debra Turner @ 601.977.7715.

The registration fee is $150 for each institution; $50 for each additional representative from that institution. Please submit payment by Friday, September 6, 2019.

Make check payable to:

Tougaloo College
Career Services
500 West County Line Road
Tougaloo, MS 39174
601.977.7815

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Annual Graduate and Professional School Form