California Council of Cultural Centers in Higher Education

CaCCCHE MEETING REGISTRATION

APPLICANT INFORMATION (*required fields)
Name:	*
Title:	*
Department:	*
Institution/Campus:	*
E-mail:	*
Phone:	*
Cell Phone:	*
Fax:

Meeting RSVP
I am RSVP'ing for the meeting on:
*Event Name:
Dietary Needs:	(ie: Vegan, Kosher, etc.)
Allegeric Information:
Get Acquainted Mixer:	Yes No
Are you attending the Thursday night No-Host Mixer?:	Yes No
Are you attending the Friday night No-Host Mixer?:	Yes No

Additional Questions
What are emerging issues topics that you would like to discuss at the retreat?