COSD Event Registration Form Fall 2015

COSD Event Registration Form

Please fill in the form below.
Full Name*

PrefixFirst NameLast Name
Company Name*
Title*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*
Please select the COSD events you will be attending*

COSD Annual National Conference (Thursday, 11/5/15)Employer Community (Friday Morning 11/6/15)FULL ACCESS Career Fair (Friday Afternoon 11/6/15)FULL ACCESS Student Summit (Friday Afternoon 11/6/15- Saturday Afternoon 11/7/15)

Hotel Accommodations
Will you be staying at the Chicago Marriott O'Hare?*

YesNo
Will you need an accessible room?*

YesNo
Do you need a roll-in shower? A roll in shower will have a zero step entry to the shower area.*

YesNo
Should be Empty:

COSD Event Registration Form