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USG Institution Reservation Form

Please complete this form and click "Continue" to submit your reservation for the 2010 Regents' Awards Celebration Event.
Deadline for reservation submission is February 22, 2010.

NOTE: No payment is required at this time. This form is for event reservations ONLY.
Please do not submit this form more than once.

Institution     -- select --   Abraham Baldwin Agricultural College Albany State University Armstrong Atlantic State University Atlanta Metropolitan College Augusta State University Bainbridge College Clayton State University College of Coastal Georgia Columbus State University Dalton State College Darton College East Georgia College Fort Valley State University Gainesville State College Georgia College & State University Georgia Gwinnett College Georgia Highlands College Georgia Institute of Technology Georgia Perimeter College Georgia Southern University Georgia Southwestern State University Georgia State University Gordon College Kennesaw State University Macon State College Medical College of Georgia Middle Georgia College North Georgia College & State University Savannah State University Skidaway Institute of Oceanography South Georgia College Southern Polytechnic State University University of Georgia University of West Georgia Valdosta State University Waycross College BOR - University System Office

Table Host

First name: (may include middle initial or name)

Last name:

Institution Contact Information   (REQUIRED FOR CONFIRMATION & RESERVATION)

Contact Name  

First name: (may include middle initial or name)

Last name:

Email Address * 

Mailing Address 1

Mailing Address 2

City

State        Zip code    

Telephone (format: xxx-xxx-xxxx)

*Guest ticket confirmation will be sent via email to the institution contact above.

Please indicate the Tables you would like to purchase. (select at least one)

  1 table 2 tables 3 tables 4 tables at the $10,000 Level

  1 table 2 tables 3 tables 4 tables at the $6,000 Level

  1 table 2 tables 3 tables 4 tables at the $4,000 Level

Names of your guests, if known (10 per table).
Please enter each name on a separate line.

Table 2 Guests (if applicable)

Table 1 Guests

[ Add more tables ]

Table 4 Guests (if applicable)

Table 3 Guests (if applicable)

If you do not know the names of all your guests at this time, please provide them to mcarr@uga.edu by March 5, 2010.

     

You will have the opportunity to review all entries before final submission.