2012 Beta Beta Beta Northeast District II Convention - Demographics / Payment Form

Each attendee should submit a separate registration form.  Please contact Cindy Surmacz (csurmacz@bloomu.edu) if you have any questions. Please pre-register by Monday, March 12, 2012. Registration forms will also be accepted onsite.

Demographics
Payment

*Please indicate payment choice, which includes lunch, snacks, and registration fees (checks can be mailed or brought to the conference):

Please mail checks to “Beta Beta Beta.” On the memo line, write “TriBeta Convention Fee.” Please mail checks by March 12th 2012 to:
Cindy Surmacz
Dept. of Biological & Allied Health Sciences
Bloomsburg University
400 E. Second Street
Bloomsburg, PA 17815