Fillable Printable Open House Registration Form - Minnesota

Open House Registration Form - Minnesota

OPEN HOUSE REGISTRATION FORM

Please complete legibly:

Name: ______________________________________________________________________________

Email address (used for confirmation): ____________________________________________________

Cell # (or best contact #): _______________________________________________________________

College or University granting degree: ____________________________________________________

Box lunch: Vegetarian option? Yes ________ No_________

Dietary restrictions or allergies: ______________________________________________

Mail this completed registration form and $15 fee (check or money order made payable to “The

Emily Program”) postmarked by Friday, November 7, 2014 to:

Carrie Peterson, MS, RD, LD, CSSD

Director, U of M – TEP Dietetic Internship

225 Food Science & Nutrition

1334 Eckles Avenue

St. Paul, MN 55108