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Office of Diversity

Midwest H.A.L.O. Encuentro 2016 Online Registration

 

Organization Name: 
                     School:
      
Mailing Address:


Contact Information:

                    Name:  
      Email Address:  
     Phone Number:  
   Alternate Phone:  

 

Number traveling with your group:  
(please submit names is space below)

Date of Arrival:         

Approximate time of arrival:

 

Group Roster: