Registration for March 9, 2007 Conference

I would like to attend:	Time	Price
____ Breakfast	8:00am	$5.00
____ Lunch	12:15pm	$15.00
____ Vegetarian Meal Option
	Total:	___________

                                 

_____________________________________________ Name

_____________________________________________ Address

_____________________________________________

_____________________________________________

_____________________________________________ E-mail Address

_____________________________________________ Phone Number

 

Method of Payment

____ Check

____ Visa

____ MasterCard

__________________________________     ________ Credit Card #                                                                    Exp. date

______________________________________________ Signature

 

Please return this registration form to the address listed below.  You may also submit your registration and payment information by phone, fax, or e-mail.

 

Institute for Teaching and Research on Women

Towson University

8000 York Road

Towson, MD 21252

Phone: 410-704-5457

Fax: 410-704-3469

E-mail: rjulian@towson.edu