Registrant Information

 

Name                  _____________________________________________

 

Affiliation             _____________________________________________

 

Address 1           _____________________________________________

 

Address 2           _____________________________________________

 

City, State, Zip    _____________________________________________

 

Phone                 _____________________________________________

 

Email                   _____________________________________________

 

 

Payment Information

 

__  $75.00   Registration

 

__  $200.00   MCLE Credit

Enclose a check or money order made out to the American Indian Studies Department and send along with this form to:

 

American Indian Studies Department

Re: California Indian Energy Symposium Registration

Attn: Prof. Joanne Barker

San Francisco State University

1600 Holloway Avenue

San Francisco, CA 94132

 

No refunds on registration will be made on requests received after January 30.
Waivers for individual registration fees are available to the non-SFSU community.
Please attach a letter of request to this form and mail to the above address.