Header 1Certificate Banquet Post 1Diagnostic Services Department/UF Certificate Banquet Registration Please complete the following form to register for the Diagnostic Services Department at The University of Findlay Certificate Ceremony and Banquet. Please note that the cost for each additional person attending the banquet with you is $10. This site is secure but if you prefer to register in person or pay with a check, please contact Lori Kloman-Williamson at 419-434-4448. First Name *Last Name *Address *City *State *State1Please Select ... US State: AL AK AZ AR CA CO CT DE FL GA 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 RI SC SD TN TX UT VT VA WA WV WI WY Zip Code *Telephone Number *E-mail Address *I will be attending the Certificate Ceremony only. I will be attending the Certificate Ceremony only.YesNoI will be attending the Certificate Ceremony and Banquet. I will be attending the Certificate Ceremony and Banquet.YesNoI will not be attending the Certificate Ceremony or Banquet. I will not be attending the Certificate Ceremony or Banquet.YesNoPlease indicate the number of any additional people attending the banquet with you ($10 each). Name on Credit Card Credit Card Number Expiration Date 3-Digit Security Code eForms by AchieveForms If you have any questions please contact the Wolfe Center for Alumni, Parents and Friends at 419-434-4516.