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 The registration fee is $125; $75 for each additional representative. Please submit payment by September 8, 2017. Make check payable to: Tougaloo College Career Services 500 West County Line Road Tougaloo, MS 39174 601.977.7815 If paying by credit card, please contact Ms. Debra Turner @ 601.977.7715.