First Name *

Last Name *

Email *

Are you with a GVSU department? *
- Select Option Yes No

Department *

Phone *

Campus Address *

Organization *

Phone *

Address 1 *

Address 2

City *

State/Province *
- Select State Alabama Alaska American Samoa Arizona Arkansas Armed Forces Afr/Can/EU/ME Armed Forces Americas Armed Forces Pacific Baker Island California Colorado Connecticut Delaware Federated State of Micronesia Florida Georgia Guam Hawaii Howland Island Idaho Illinois Indiana Iowa Johnston Atoll Kansas Kentucky Kingman Reef Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Midway Islands Minnesota Mississippi Missouri Montana Navassa Island Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Palmyra Atoll Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Trust Territory of Pacific Utah Vermont Virgin Islands Virginia Wake Island Washington Washington D.C. West Virginia Wisconsin Wyoming

Zip/Postal *

Who will be there to represent your department? Please include email addresses. If you are not sure yet, please give us a date by which you can provide this information. *

We can provide up to three (3) easels. We provide just the easels. Please let us know how many easels you would like. *
- 0 1 2 3

Please let us know if you have any concerns or additional requests (i.e. backboards & clips for easels, etc.). We will do our best to accommodate.

The Office of Undergraduate Research Fair has a number of materials we would be happy to share with you in order to promote this event with your majors. We have:

• Quarter-sheet pluggers
• 8 1/2 x 11" flyers
• Powerpoint slide

Would you like us to send you any promotional materials? *
- Select Option Yes No

If yes, please specify what materials you would like, how many, and to whom they should be sent. *