Multidiscipline Career Fair Saturday, May 12, 2007 from 1:00

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Registration form Multidiscipline Career Fair Thursday - April, 12

th

, 2012

Name of business: _______________________________________________________ Name of recruiter(s): _____________________________________________________ Address: ______________________________________________________________ ______________________________________________________________________ Phone:__________________ Fax:_______________________ Email:_____________________ Discipline recruiting (circle all that apply) PT OT SLP Amount Paid-$200.00/booth (circle one) Check Money Order $250.00/booth After March 22, 2012 $_____________ # of booths __________ Special requirements: ______ electrical outlet (first requested, limited number available) ______ number of parking passes needed Please make check or money order payable to:

Eastern Washington University

EWU Tax ID number 91-6000624 Please mail form and payment to: Eastern Washington University Department of Physical Therapy

Attn: Cindy Crago

Box T 310 N. Riverpoint Blvd. Spokane, WA 99202-1675

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