California State University, Dominguez Hills | INSERT YOUR DEPARTMENT NAME HERE

Student Registration Form
Deadline to register: Monday, June 2nd, 2008
Please print this form and bring it to the Student Development Office Welch Hall D-360
with your check for $10 payable to:
CSUDH Foundation-Student Development

First Name:                  Last Name:
Address:
City:   State:   Zip:
Phone:   Cell:
E-mail:
CSUDH Student       CSUDH Alumni
Major:    Graduation Date:

Questions? Contact: Larry Gray, Director
Phone: (310) 243-3625 Fax: (310) 516-3651

Deadline to register: Monday, June 2nd, 2008.
No Refunds after June 3.

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