Participant's Name: University or College Name:
School Address: City: State:
Zip Code:
Contact Number (Cell): E-Mail Address:

Permanent Home Address:
City: State: Zip Code:
Office Number: Home Number:

School Information
 Classification:   Senior   Junior   Sophomore   Freshman   Advisor  
Anticipated Date of Graduation Major:
Career Goal:

Organization(s)
 Organization: Office Position(s):
Organization: Office Position(s):
Fraternity/Sorority Affiliation: Intake Date:
Office(s) Held:

Institute Registration
*Payments must be postmarked by Wednesday March 31, 2010
 On or Before Wednesday, March 31, 2010         $525.00
After Wednesday, March 31, 2010                     $650.00
Advisors with a single room                              $675.00 (Advisors Only- one price)

NASAP - SLI will provide a Free Tee shirt for every participant.
 Please fill in the size for your shirt below:
Small Medium Large XLarge XXLarge XXXLarge

Institute Meals
 Meals included in the registration cost - Meals are not included for evening activities off campus.
Regular Vegan Vegetarian

Please refer to the Salisbury-Ocean City Wicomico Regional Airport information in the registration brochure. Mail completed registration form with payment made payable to:

University of Maryland Eastern Shore
Office of Student Activities - Suite 2104
30665 Student Services Center - UMES
Princess Anne, Maryland 21853

Payment can be in the form of check, crediit card, money orders or purchase orders only. For credit card purchase, call (410) 651-6434.
Don't Forget To Bring Fun Promotional Items As Hand Outs To Promote Your School For the Silent Auction!
© copyright 2009 - 2012