Please provide the following information as soon as possible to reserve your table and be
included in the program.  Due to the anticipated response, you may want to fax this form
immediately, then requisition payment. This form and your payment should be returned to
the address indicated below. Thank you!

1. Organizational Information

          Organization:                                                                       Web Site:                                    
          Type of Organization:                                                                                                       
          Primary Product/Service:                                                                                                       
          Address:                                                                                                                               

          Primary contact:                                                              Title:                                               
          Telephone:                                  Fax:                                    E-mail:                               

          Representatives attending [include name(s) and email address(es)]:

          1.                                                                                                                                         
          2.                                                                                                                                         
          3.                                                                                                                                         

2. Career Opportunities

Typical positions for college graduates with 2 – 10 years of experience:                             
                                                                                                                                            

3. Special Requests (Please check appropriate items)

q I/we plan to bring a display (indicate type/size of a display)
         Free-Standing         q Tabletop         q Banner         q Other
q I/we will need access to an electrical outlet
q Other (please specify):                                                                                                      

4. Registration Fee & Deadline
The registration fee is $600. Please make check payable to Widener University/ACCESS.
q Check in process                  Check #                                                  
Authorized Signature:                                                                                                     

          Return Form and Check to:
                                Meghan Mogan                                                                                               phone: 610-399-4588
                                PACNet Administrator                                                                                fax: 610-399-0913
                                P O Box 603
                               Chadds Ford, PA 19317