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*  First Name:
* Last Name:
* Title:
*  School:

*First Name:  *Last Name:  *Title:  *School:  *Address:  *City:   *State:  [ choose one ] AA AE AK AL AP AR AZ CA CO CT DC DE FL GA GU HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA PR RI SC SD TN TX UT VT VA VI WA WV WI WY ZZ (For foreign addresses enter ZZ in state and zip code fields, and input country in country field.) *Zip Code:  Country:  Province:  Foreign Zip:  *Phone:  Fax:  *Email:  *Our auditors require us to ask a personal identification question in lieu of your signature. This year's question is: In what month were you born?

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Please provide the following information on your school and its foodservice operations:

• School enrollment: 



• Type of school:
Residence
Commuter



• Number of dining facilities on campus: 



• Type of operation:
Institution-operated
Leased
    If leased, company name of lease operator: 



• Number of students on meal plan: 

  Do you have access cards?    Yes No

• Number of foodservice employees: 

  Full Time: 

  Part Time: 

• Annual food/beverage purchases: $ 

  (include alcoholic beverages if applicable.)
  Do you sell alcohol?    Yes No



  Is there a convenience store (or stores) on campus?    Yes No
  If yes, who oversees it (them)?
Food Service
Bookstore
Other     
  How many stores? 
  Total Annual Revenue: $ 



• Is your school a member of:

  NACUFS?   Yes No

  ACAP?   Yes No

  NACAS?   Yes No

  NACS?   Yes No

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List below the names and titles of anyone at your facility you want to receive a FREE subscription to On-Campus Hospitality. (We're sorry–but names without titles cannot be processed.)

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If you have any questions, please call the Circulation Department
at 516-334-3030

or email us at
ebmcirc@ebmpubs4.com