Conference Registration Form

Name:
Address:
Phone:
E-mail:
Affiliation (if any):
   
   Attending Dinner with Patricia Williams ($35/person)*
   
   Attending Working Breakfast
        Area of interest:
   
      If attending dinner or breakfast, please indicate:
           Vegetarian
           Non-vegetarian
   
   Attending Public Encounters (choose one):
           Tour of Bronzeville
           South Side Tour
           Meeting w/ "Video Machete"
   
   

        *Please make checks payable to:
        UIC, College of LAS, Dept. of External Affairs

        Mail checks to:
        Office of External Affairs (MC 228)
        University of Illinois at Chicago
        803 University Hall
        601 South Morgan Street
        Chicago, Illinois  60607-7104