Associated Students of Willamette University

Community Registration

Full Name*
Are you a Willamette Alum?	Yes No
Alumni Year
Social Justice interest or experience	Immigration Education Health Poverty Sustainability
Other Social Justice interest/experience	Interest or experiences other then listed above.
Title	If you gained any experience, please list your title.
Group/Organization/Company	Please list the Social Justice group you gained experience with.
Attending the SSRD program	Are you attending the SSRD program on April 17th (9-5pm)? Yes No
“Breaking the Bubble” event	Are you attending the “Breaking the Bubble” event on April 17th (3:30-5pm)? Yes No
Space to display informational materials	Would you like space to display informational materials about your Group, Organization, or Company? Yes No
If yes, what materials will you bring?

Associated Students of Willamette University Willamette University 900 State Street
Salem, Oregon 97301 (503) 370-6058 voice