Registration Form

ESU Athletic Training 30 Year Celebration

Registration

$30 Per Person (only $1 per year!)

Please return this form along with a check or money order to:

ESU Foundation-Athletic Training

Barbara A. Harrison
Secretary
Athletic Training Department
Koehler Fieldhouse
East Stroudsburg University
East Stroudsburg , PA 18301
(570) 422-3231

____ YES! I will Attend

# of Adults ____ X $30 = Total $ __________

____ I would like childcare arrangements

# of children ______ Ages______________________

____ No, I cannot attend (But I would like to contribute to helping maintain ESU's proud tradition in Athletic Training Education)

Enclosed is a donation in the amount of ________to the ESU Athletic Training Scholarship Fund.

***If you are unable to attend we encourage you to send us a video, letter or e-mail that we can share in your absence.***

Name ____________________________________________________

Class of _________ E-mail__________________________________

Phone # __________________ Table Sharing Requests/Comments

_________________________________________________________

Shirt Size: S M L XL XXL