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Overview

Event Program

Keynote Speaker

Dream Awards

Service Learning Opportunities

Event FAQ
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Please fill out and submit the following form to reserve your place at the 2012 Annual Unity Breakfast.

An asterisk (*) indicates a required field.

Contact information
Title:* Dr. Mr. Mrs. Ms.
Attendee first name:*
Attendee last name:*
2nd attendee first name: (if applicable)
2nd attendee last name: (if applicable)
Company name:
Address line 1:*
Address line 2:
City:*
State:*
Zip code:* [ ##### or #####-#### ]
Phone:* [ ###-###-#### ]
Email:* [ username@domain.com ]
Registration:*

General admission ($15)
General admission (2 attendees) ($30)
General admission (3 attendees) ($45)
General admission (4 attendees) ($60)
1 Adult and 1 Child (10 and under) ($20)
1 Adult and 2 Children (10 and under) ($25)
2 Adults and 1 Child (10 and under) ($35)
2 Adults and 2 Children (10 and under)($40)

Payment method
Submitting payment through PayPal using VISA, MasterCard or Discover will speed up the registration process. You may also print and mail this form with a check if you do not wish to submit it electronically. Mailed forms must be received by January 7, 2012. Mailing instructions can be found below.
Payment:* PayPal (VISA/MasterCard/Discover)
Check/Money Order (Mail Only)

*UW Tacoma Student tickets must be purchased through the Office of Student Affairs (MAT 103).
**If your ticket option is not in the payment tab above, please contact us at 253-692-4501 and we can register your party.

Questions may be directed to Anna Mertz at (253) 692-4501 or via e-mail.
To request disability accommodation for this event, contact Anna Mertz at least 10 days in advance of the event: 253-692-4501 (voice); 253-692-4413 (TTY); 253-692-4398 (fax); mlkuwt@uw.edu.

Forms and payment may be mailed to:

University of Washington Tacoma
Office of Student Affairs
1900 Commerce Street
Tacoma, WA 98402-3100
Please make checks payable to "University of Washington Tacoma"
Please take a moment to review what you have entered, pressing the submit button below transmits your registration only. Reservations are only guaranteed for the first 300 paid attendees. Please make payment as soon as possible.On the confirmation page, you may finish your payment for this event through PayPal's secure pages.

University of Washington Tacoma
1900 Commerce Street - Tacoma, WA 98402-3100
(253) 692-4400 - FAX (253) 692-4414

Last update: 12/29/11