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Please fill out and submit the following form to reserve your place at the 2013 Annual Unity Breakfast.

UW Students must use the UW Student ONLY registration form. There is no online payment option for students through this form!!!

An asterisk (*) indicates a required field.

Contact information
Title:* Dr. Mr. Mrs. Ms.
Primary attendee
First Name:*
Primary Attendee
Last Name:*
Additional Attendees:
(if applicable)
Organization Name:
(if applicable)
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 General Admission and 1 Child (10 and under) ($20)
1 General Admission and 2 Children (10 and under) ($25)
2 General Admissions and 1 Child (10 and under) ($35)
2 General Admissions and 2 Children (10 and under) ($40)
Other: Please see instructions below.

Payment
Submitting payment through PayPal using VISA, MasterCard or Discover will speed up the registration process. You may also use the mail-in form. Mailed forms must be received by January 18, 2013. Mailing instructions can be found below.
Payment and registration questions may be directed Student & Enrollment Services at (253) 692-4501 or via e-mail to mlkuwt@uw.edu. Please note the following:
  • If one of the packages listed above do not fit your registration needs, you will need to use the mail-in registration form or register over the phone.
  • UW Students must use UW Student ONLY online registration form or use the mail-in form. There is no online payment option for students by submitting this form.
  • To request disability accommodations for this event, contact us at least 10 days in advance.
Payment Method:* PayPal (VISA/MasterCard/Discover)
Check/Money Order (Mail Only)

If using the mail-in registration, mail forms and payment to:

University of Washington Tacoma
Office of Student & Enrollment Serivices
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 (please be sure you have chosen that option above).

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

Last update: 1/17/13 -->