Jinahie (Take Back the Night) Staten Island Campus - Registration Form

Date
October 5th, 2011

Time
6:30 PM

Location
Great Lawn, Staten Island Campus

Personal Information

Prefix:

First Name:

Last Name:

E-mail:

Phone:

Department:

Your role (student, faculty, employee, community member?):

Number of students you are bringing to this event:

Number of other guests you are bringing to this event:

Event Selection

I will attend:

Jinahie (Take Back the Night)