I am a...
 
 
 
 
First Name:*
 
 
 
 
Last Name:*
 
 
 
 
Email:*
 
 
 
 
Phone Number:*
 
 
 
 
Job Title
 
 
 
 
Company
 
 
 
 
Will you be bringing any additional representatives from your company? (If yes, please indicate how many)
 
 
 
 
Would you like to participate virtually via Zoom? (Limited spots available)
 
Yes
No
 
 
 
Student Number
 
 
 
 
Do you want a student business card?
 
 
 
 
Full name you'd like printed on your KPU Brewing student business card:
 
 
 
 
Email to be printed on your student business card:
 
 
 
 
Phone number printed on your student business card:
 
 
 
 
List your top 3 breweries you'd like us to invite: