Health Careers Networking Reception Registration

February 20, 2013, 3:30-5:30 p.m. Calvin's Prince Conference Center Calvin students seeking nursing externships and full-time positions attend this fair.

ORGANIZATION INFORMATION
Organization name:

Organization address:

Brief description of organization:

Website:

Name of primary contact:

E-mail address of primary contact:

Will primary contact attend the event?	Yes No

Names and e-mail addresses of representatives who will attend the event:

Number of representatives who will stay for dinner after the event:

Special needs:	Electrical outlet Food-related, please specify: Other:
JOB INFORMATION
Positions for which you'll be recruiting:

Geographical location(s) of positions:

PAYMENT INFORMATION WILL BE ON NEXT PAGE AFTER CLICKING SUBMIT $50 for 2 representatives, $25 for each additional representative.