BSCS
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Participant Information

Name (include title and degrees):
Organization/School
Department:
Business Address:

Business Phone:
Fax:
Home Phone:
Email:
Home Address:

Preferred Beverage (Diet Coke, Pepsi, Water, etc.):
Dietary Restrictions:
Physical Restrictions:
Room Preference: Non-smoking
Smoking
What is the best form of communication to use for correspondence? Email
Business Phone
        Best times:
Home Phone
        Best times: