<div style="width:500px;">
<script type="text/JavaScript" src="http://www.siue.edu/transfer/transfer.js" language="JavaScript"><!----></script>
<table width="500" border="0">
<tr>
<td>
<h2>SIUE 2011 Community College Conference Registration</h2>
<p>This form will register you for the SIUE Community College Conference scheduled for Thursday, October 13, 2011. The conference will take place on the campus of Southern Illinois University Edwardsville and is intended for community college advisors. It will include:</p>
<ul>
<li>updates from the Office of Admissions and the Transfer Center</li>
<li>presentations from SIUE Academic units</li>
<li>lunch</li>
<li>campus tour</li>
</ul>
<p>If you have any questions, please contact:</p>
<blockquote>
<p>Evan Wilson — <a href="mailto:ewilson@siue.edu">ewilson@siue.edu</a>, (618) 650‑2505<br /> Lori Anderson — <a href="mailto:landers@siue.edu">landers@siue.edu</a>, (618) 650‑2937</p>
</blockquote>
<form onsubmit="return checkFieldsCCCRegistration()" name="cccregistrationform" action="http://www.siue.edu/cgi-bin/FormMail.pl" method="post" id="cccregistrationform">
<p><input name="recipient" type="hidden" value="landers@siue.edu" /><input name="subject" type="hidden" value="2011 Community College Conference Registration" /><input name="redirect" type="hidden" value="http://www.siue.edu/transfer/ccc-thanks.shtml" /></p>
<p><input name="first_name" size="40" maxlength="40" type="text" value=" First Name" onfocus="this.select()" /></p>
<p><input name="last_name" size="40" maxlength="40" type="text" value=" Last Name" onfocus="this.select()" /></p>
<p><input name="college" size="40" maxlength="40" type="text" value=" College" onfocus="this.select()" /></p>
<p><input name="email" size="40" maxlength="40" type="text" value=" Email" onfocus="this.select()" /></p>
<p><input name="phone" size="40" maxlength="40" type="text" value=" Phone Number (555-555-5555)" onfocus="this.select()" /></p>
<p></p>
<p><input name="Submit" type="submit" value="Register Me!" /><br /> <br /> <br /><input name="Reset" type="reset" value="Reset" /></p>
</form>
</td>
</tr>
</table>
</div>