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Spring 2013 Open House Registration

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Please complete and submit your registration information for the 2013 Spring Open House on Friday, March 22, 2013

(1)First Name : *

(2)Last Name : *

(3)Email Address : *

(4)Phone Number : *

(5)Street Address : *

(6)City : *

(7)State : *

(8)Zip Code : *

(9)Number of guests attending : *

(10)Student Status : *

Winston-Salem State University

601 S. Martin Luther King Jr. Drive

Winston-Salem, NC 27110

Phone: (336) 750-2000

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