REGISTRATION

PLEASE NOTE

All attendees must pre-register for the conference via mail. Feel free to copy and distribute the form.

Send your completed form to:

Race in 21st Century Conference
Michigan State University
James Madison College, 367 S. Case Hall
East Lansing, MI 48824

Complete one registration form per individual.
All information must be completed in order to process this form.

Deadline Notice

REGISTRATION EXTENDED UNTIL APRIL 2, 2007
No registration forms will be processed without full payment.
No registrations will be accepted by fax.
No registrations will be accepted at the door.

Also - Unless the conference is cancelled, there will be absolutely no refunds, for any reason [i.e. weather, personal conflict, etc.] after April 2, 2007*. Registration fees are refundable [less a $50.00 cancellation fee] if a written notice is received on or before April 2, 2007*.

*DEADLINE EXTENDED

PDF Form

Click HERE for a PDF Version of the Registration Form

HTML Form

Please print legibly or type:
(Select text, copy, and paste into Microsoft Word or equivalent)

Title: Rev. Dr. Mr. Mrs. Ms. Gender: M _____ F _____

Name: _______________________________________________

Address: _____________________________________________

City: ___________________ State: _____ Zip: _______________

Phone: _________________ Fax: _________________________

Email: _______________________________________________

FOR STUDENTS ONLY

Student Education Profile: [please check one]

_____Middle School _____High School _____College

School Name:________________________________________________

CONFERENCE PACKAGES:

_____$155.00 [Conference with lunches on April 5 & April 6, 2007]*

_____$125.00 [Conference without lunches]

_____$30.00 [MSU Faculty/Staff/Students with lunches April 5- 6, 2007]*

_____$15.00 [Low income fee]

_____ FREE [MSU faculty/staff/students without lunches]

*Would you like a vegetarian meal? Yes _____ No _____

AMOUNT ENCLOSED $__________

Make money orders and checks payable to Michigan State University.

Mail registration form[s] and fee[s] to:

Race in 21st Century Conference
Michigan State University
James Madison College, 367 S. Case Hall
East Lansing, MI 48824