Career Services and Job Placement

Registration Form
Please complete the following registration form to participate in this event. Fields marked with an * are required. The registration fee for this event is $30 - you may mail your fee to:

Western Wyoming Community College
C/O Brenda Haskins
2500 College Dr.
Box D-520
Rock Springs, WY 82901

To pay by credit card, please call Brenda Haskins at (307) 382-1660 M-F from 8:00 am -5:00 pm.

Note: Payment is due prior to the event date. Failure to make payment by this date may prevent your participation in the event.

CONTACT INFORMATION
Primary Contact Name*
Telephone*
E-Mail Address *

COMPANY INFORMATION
Company Name*
Address*
Address*
City *
State *
Zip Code *
Country *
Web Site
Company Profile *
Business/Industry *

REGISTRATION INFORMATION
The registration fee includes: table, chair, lunch for one recruiter. Admission for each additional representative is $10.00.
Number of representatives who will attend the event:*
Names of representatives who will attend the event *
Representative 1 (Name)	(Title)
Representative 2 (Name)	(Title)
Representative 3 (Name)	(Title)
Representative 4 (Name)	(Title)
Facility Arrangements: Please select any additional requirements that you have below. Space is assigned in order of date registration is received. Electricity Extra Chairs Interview Room

The registration fee for this event is $30 - you may mail your fee to:

Western Wyoming Community College
C/O Brenda Haskins
2500 College Dr.
Box D-520
Rock Springs, WY 82901

To pay by credit card, please call Brenda Haskins at 307-382-1660 M-F from 8-5.

Note: Payment is due prior to the event date. Failure to make payment by this date may prevent your participation in the event.

Mark Rembacz
Career Services and Placement Coordinator
(307) 382-1646

Peg Larson
Occupational/Student Success Advisor
(307) 382-1828

Brenda Haskins
Career Services and Job Placement Assistant
(307) 382-1660