PSU Visitor Computer Registration Form

• Your first name, middle initial and last name:
• Home Telephone Number*:
• The email address you will use most often while at PSU*:
• What group or conference are you attending while visiting PSU*?
• What is the name of the PSU person who is the contact person for your group. If you do not know a specific person, please indicate a department or organization name*:
• What is the name of the person who is the leader of the group you are attending with?*
• What are the dates for your conference or institute?*
• Address Line 1*:
• Address Line 2:
• City*:
• State*:
• Zip Code*:

By submitting this information to Plymouth State University, you are hereby agreeing to all of the same policies and procedures that PSU employees and students agree to when requesting permission to access any network services. All policies can be found at: http://www.plymouth.edu/infotech/policy/