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2013 STAFF DEVELOPMENT DAY LUNCH - ELECTRONIC PAYMENT

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Title:   *First Name:    *Last Name: 
*Campus Mailing Address:
Department or School:
*Campus Phone:  
*E-mail:
Have you ever attended the Staff Development Day Luncheon before? Yes No
How did you learn about this Event?
Would you like an Executive Board member to contact you with regards to volunteering on a committee or getting involved with SMUSA on the board level? Yes No

Payment Information:
Please make sure the name and address you enter here matches your credit card billing information.
*First Name:    *Last Name: 
*Street Address:
*City:    *State:    *Zip:
*Billing Phone:
 

Your Registration Total $