Please download (using Acrobat) the form as a PDF document or simply print out the form,
complete all information, make the proper selections, and mail the form with
payment to the address at the bottom of the form. Please note that advance
registration will close February 15, 2008 or when the number of registrations
reaches 130.
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Name |
First |
Middle |
Last |
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Affiliation |
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Mailing Address |
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Phone No |
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Fax No |
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E-Mail |
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____Advance Registration |
____Student: $40 ($30 for one day)
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$________ |
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____NCJTA Member: $40 ($30 for one day)
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$________ |
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____Faculty/Other: $50 ($40 for one day)
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$________ |
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____On-site Registration |
____Student: $50 ($40 for one day)
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$________ |
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____NCJTA Member: $50 ($40 for one day)
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$________ |
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____Faculty/Other: $60 ($50 for one day)
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$________ |
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Saturday Evening Wine and Cheese Reception
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Please choose: |
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Saturday Lunch $15
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Please choose: |
$________ |
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Sunday Lunch $15
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Please choose: |
$________ |
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Total Amount Enclosed |
$________ |
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Method of Payment: The payment should be by a personal US bank check or an international money order/bank draft payable to: University Corporation, SFSU (ICPLJ)Please return the registration form and payment to:
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