Plastics and Advanced Manufacturing Day

Registration Information

I am registering as a(n):

Individual

School Group

First Name

Last Name

Email Address

Birthdate

Mailing Address

Country

Street

City

Region

Postal Code

Mobile Phone

I would like to receive text messages from Shawnee State University

Yes

No

High School Attended

Graduation Year

What is your intended major or area of study?

Including yourself, how many will attend? (If you are attending with a group, do not count them as guests)

School or Organization Name

Estimated number of students attending:

Contact Name:

Contact Title:

Contact Phone:

Contact Email:

Please list any accommodations needed: