1.	Organization*
	Organization Name   Web site

2.	Primary Contact Person (Principal, Teacher, or Recruiter)*
	Full Name   Title

3.	Primary Contact E-mail Address*

4.	Secondary Contact Person (Teacher, Administrative Assistant, HR representative, Recruiter or any other affiliate needing information about this event)*
	Full Name   Title

5.	Secondary Contact E-mail Address*

6.	Phone Number (including ext.)*

7.	Fax Number

8.	Mailing Address*
	Address Line 1   Address Line 2   City   State   ZIP

9.	Organization Description* Please provide as much detail as possible to assist students in evaluating your organization as a potential employer.