Northeastern Illinois University :: Mini-Kane Registration

Mini-Kane Online Registration Form

First Name:

Last Name:

Company:

Affiliaton:

Email Address:

Billing Address:

City:

State:

Zip Code:

Phone Number:

Yes, I plan to attend.

No, I can't attend, but I am making a contribution to NEIU Chuck Kane Scholarship.

Admission Package:

Quantity:

Additional donation amount:

Are you interested in joining the student planning committee for Mini-Kane 2014?

My contribution to the NEIU Chuck Kane Scholarship is: