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

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Registration form
Multidiscipline Career Fair
Thursday - April, 12th, 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)
$250.00/booth
Check
Money Order
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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