Please print this form, fill out all information, and mail it with your check to the address below.
| Personal Data | Fees | ||
| (please write names and affiliation as they should appear on your badge) | (please check the appropriate amounts and write in the total at the bottom) | ||
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First Name:
|
Preregistration
(before 3/15) |
_____ $20 Student
_____ $50 Faculty |
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|
Last Name:
|
Regular Registration
(after 3/15) |
_____ $30 Student
_____ $60 Faculty |
|
|
Affiliation:
|
Banquet (optional) | _____ $30 Prime rib
_____ $30 Salmon _____ $25 Vegetarian |
|
|
Address:
|
Total registration amount | ______________ | |
|
Phone:
|
|||
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E-mail:
|
| Checks must be made out to:
University of Illinois-LSRL All fees listed are US Dollars and all checks should be drawn on US banks, and properly encoded for the Federal Reserve System. |
Registration and fees should be mailed to:
LSRL Conference ATTN: Kim Potowski University of Illinois at Chicago Department of Spanish, MC-315 601 S. Morgan Street #1727 UH Chicago, IL 60607 |