REGISTRATION FORM by T66DN35

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									                                          REGISTRATION FORM

                             “PHOTOGRAPHY: THE DOCUMENT”

                                October 14, 2011, 8:30 AM – 4:30 PM
                     University of Louisville, Ekstrom Library, Chao Auditorium
Please complete and return with payment no later than October 10

NAME         _____________________________________________________________
                        Last Name             First Name

ADDRESS       Must have:


              _____________________________________________________________

PHONE         __________________________            EMAIL________________________________


                                                  PLEASE READ
          * Participants are asked to register & pay no later than October 10
          * Make checks payable to “University of Louisville” (US funds only)
          * Registration fees are non-refundable

Fees      (Due by October 10 postmarked)

Registration (regular) $20
Students with valid ID card are free to attend but must register by October 10
*registration fee includes light continental breakfast and lunch

     Vegetarian meal/s requested



Payment Information:

 Check Enc. Check #                Check Date

 Visa  MasterCard          Expiration date:    /___
Acct. #                                   3 # code (from the back of the card )__________

Signature:

                    (Required for Credit Card Payments)


Please send the registration to:
Attn. Janna Tajibaeva
Conference Coordinator
“PHOTOGRAPHY: THE DOCUMENT”
Arts and Sciences Dean’s Office
Gardiner Hall
University of Louisville, Louisville, KY 40292

If you have questions please contact: (502) 852-2247 or janna@louisville.edu

								
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