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Event Registration Form 

Personal Information

First Name:  Last Name: 

Role:  (Choose the role that best applies)

Phone Number: 

Email Address: 

Emergency Contact Person (Only applicable to off campus events): 

Emergency Contact Phone Number (Only applicable to off campus events): 


Event Information

Event Name: 

Hosting Organization:  

Club/Organization Affiliation (if none apply, please leave this field blank)  

Dietary Needs (if none apply, please leave this field blank)

If you selected the Allergies Box, please list your Allergies here

Comments: 

Accommodations

If you or your guest requires any disability related accommodations or arrangements, please contact Maria Schiano at the Office of Disability Services by phone at 908-526-1200 ext. 8418 or by email at mschiano@raritanval.edu.   

 


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