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Welcome to the official website for the
California Forum for Diversity in
Graduate Education

Fall 2008 at University of California, Berkeley
Saturday, November 8, 2008


Recruiter Registration Form
  

Please fill out this form completely and submit your registration.
Required fields are marked with an asterisk (*).

First Recruiter

    * First Name
    * Last Name
    * Title
    * School/Department
    * College/University
    * Campus or Street Address 1
       Campus or Street Address 2
    * City
    * State/Province
    * Zip + 4/Postal Code
    * Telephone Number
       [e.g., 555-555-5555]
    * E-mail Address

Second Recruiter

    First Name
    Last Name
    Title
    School/Department
    College/University
    Campus or Street Address 1
    Campus or Street Address 2
    City
    State/Province
    Zip + 4/Postal Code
    Telephone Number
    [e.g., 555-555-5555]
    E-mail Address

* Date of Registration

    I wish to register for both the Forum at University of California, Berkeley on Saturday, November 8, 2008, and for the Forum at California State University, San Marcos on Saturday, April 25, 2009. Forum staff will verify that the appropriate fee is assessed.
     

    This is the first table registration my college/university at these two Forums (Fee = $750)

    This is the second table registration my college/university at these two Forums (Fee = $750)

    I wish to register for the Forum at University of California, Berkeley on Saturday, November 8, 2008 ONLY.
     

    This is the first table registration my college/university at the University of California, Berkeley Forum (Fee = $450)

    This is the second table registration my college/university at the University of California, Berkeley Forum (Fee = $450)

    I am unable to attend, but please keep me on your mailing list for future Forums.

Payment Options

    * Payment options:

    Please invoice my college or university.

    If you wish to pay by CHECK, please make checks payable to:
    CALIFORNIA FORUM FOR DIVERSITY (FED ID# 95-6106694). Mail your payment to Keith Polakoff, Director, California Pre-Doctoral Program, CSU Office of the Chancellor, 401 Golden Shore, 6th Floor, Long Beach, CA 90802-4210.

    If you wish to pay by CREDIT CARD, please call Keith Polakoff at (562) 951-4774 or Sara Zaragoza-Oliva at (562) 951-4775. They will take down the necessary information over the telephone. In that way (and in accordance with our new security policy), your credit card information will never be recorded in a computer database.

    For questions, please contact Keith Polakoff at kpolakoff@calstate.edu or (562) 951-4774.

© University of California