REGISTRATION FORM

Fill out this form on-line!

First name Initial

Last name

Department

Institution

Address

City State Zip code

Country

Phone(s)

Fax

E-mail

Web page

Please choose one of these options:

Pre-registration fee: US $ 50.00 yes no

Banquet: $ 20.00 yes no

Lunches: $ 7 ea (maximum 3 lunches per person) yes no

Total payment:

Make checks payable to:
University Auxiliary Services, Inc. at
Albany

Please send payment at your earliest convenience with the printed Registration form to:

Department of Latin American and Caribbean Studies
Social Sciences 250
University at Albany
Albany, NY 12222

Please write your comments, if any, below:

|


Return to homepage