| Vendor Form for CCSC:SE Conference 
         
Please make your check payable to CCSC for the amount of $50. Mail your check along with this form to Dr. Julia Benson-Slaughter at: Department of Mathematics/Computer Science/Engineering                                 
                               Company Name ________________________________Contact Person _________________________________Address _______________________________________             _______________________________________
   _______________________________________ Telephone _____________________________________E-mail
  ________________________________________ Number of people attending:                        Any special requirements?_______________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ If you are interested in attending the conference banquet or luncheon, please include $25 per ticket to the banquet and/or $10 per ticket to the luncheon in your payment. |