COSD Event Registration Form Fall 2015

COSD Event Registration Form

Please fill in the form below.
Full Name *

Prefix First Name Last Name
Company Name *
Title *

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number *

Area Code Phone 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? *

Yes No
Will you need an accessible room? *

Yes No
Do you need a roll-in shower? A roll in shower will have a zero step entry to the shower area. *

Yes No
Should be Empty: