2020 GCSSC Group Registration Form

Institutional/Group Registration (for groups of 8 or more)

PAYMENT: $500. Please mail check to:

Brazosport College
c/o Dr. April Sikorski
500 College Drive
Mailbox 55
Lake Jackson, Texas 77566.

Checks should be made payable to Brazosport College. We are unable to accept electronic payments.

Contact Person:*

First NameLast Name

Institution*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Contact Email:

Number of Attendees in your group*

Phone Number

Area CodePhone Number

Names of Attendees from your Institution:

Names of Presenters from your Institution:

Dietary Restrictions

YesNo

If yes, how many will attend?*