Facilitator / Coordinator Name: (ex: Kevin Nakano)

SACC Event Name: (ex: 90 Second Networking)

Event Date: (ex: Thursday, August 5, 2010)

Preferred Method for Ambassadors to Contact You: (ex: e-mail)

Your Contact Info: (ex: kevin'semail@gmail.com)

Confirm Your Contact Info: (ex: kevin'semail@gmail.com)