Veterans Affairs - University of Evansville

Honoring Women Veterans Conference Registration

Personal Information

Please register your attendance by May 21, 2012

*First Name

*Last Name

*Street Address

*City

* State

* Zip Code

*E-mail Address

*Phone Number

Gender

Male Female

Service Information

Branch of Service

Rank

Years of Service (i.e. 1945-1947)

War Zone Service?

Yes No

Where?

Lodging

Limited residence hall lodging is available for Friday night on the University of Evansville campus - single room: $31; double room: $21. Residence halls require individuals of the same gender to occupy rooms. Payment is due upon check-in by cash or check made payable to the University of Evansville, memo line: Women Veterans Conference.

Do you plan to stay at UE?

Yes No

What type of room do you prefer?

Single ($30) Double ($20)

Do you have a disability that requires special accommodations? If so, please contact Cherie Leonhardt at 800 423-8633 x2141.

Yes No

Questions / Comments

If you have questions, additional information, or comments, please enter them here.

For question regarding your registration or lodging, please contact the UE Office of Veterans Affairs at 800-423-8633, ext. 2141 or 812-488-2141, or e-mail at hwvc@evansville.edu.

Veterans Affairs

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