PART 1 Directions: To register, complete the form below. All information is required, including an IDCC number.

PLEASE NOTE: The IDCC must be in the amount of $60 per attendee, submitted to "&CSS" and state that it is payment for the User Services Conference.

First Name:

Last Name:

E-mail address:
Example: xyz123@psu.edu

Campus Phone Number (including area code):

Status (please choose one): Faculty Researcher Staff Student Employee Other

Location (please choose one): University Park Abington Altoona Berks Beaver Brandywine Dickinson DuBois Erie/Behrend Fayette Great Valley Harrisburg Hazleton Hershey Lehigh Valley Greater Allegheny Mont Alto New Kensington Penn College Schuylkill Shenango Wilkes-Barre Worthington/ Scranton York Other

IDCC Number
DO NOT ENTER DOLLAR AMOUNT OR BUDGET NUMBER
(Conference cost is $60)

Check here if there will be multiple attendees on this IDCC.

Special Accommodations Directions: Please indicate if you have any special accommodation needs and use the box provided to let us know how we can assist you.

I need special accommodations (including special dietary requirements)

Please explain any special accommodation needs here.