Scholarship Celebration Student RSVP

Please complete the following form to register to attend the 2013 Scholarship Celebration event scheduled for Thursday, April 11, 2013.

The event will take place at the WKU South Campus located at 654 Campbell Lane. Registration begins at 5:00 p.m. and dinner begins at 6:00 p.m.

Please contact Laurie Basham at 270-745-5082 or email laurie.basham@wku.edu with any questions or concerns.

Last Name

First Name

Middle Initial

Email Address *

Telephone Number with Area Code *

Name of Scholarship

Will You Attend

Yes
No
Yes, but I need a class excuse

Class Name

Professor's Name

Name preference (for name tag)

Dietary or Handicap Restrictions

Yes dietary
Yes handicap
No

If yes explain

Any additional comments?