Name: __________________________________________
Title/Affiliation: ______________________________(as will appear on badge)
Address:__________________________________________
__________________________________________
email:________________________ FAX:________________
| $70.00 | |
| $35.00 Faculty
$20.00 Grad Student |
|
| $18.00 | |
Note: This day is a UCLA holiday. No campus restaurants will be open. |
$20.00 |
| $15.00 | |
| $30.00 | |
| Total amount enclosed:____________ |
Please make your check or money order in U.S. funds payable to the Western Society for French History and send it with this form to Prof. Charlie R. Steen, Treasurer, WSFH, Department of History, University of New Mexico, Albuquerque, New Mexico 87131-1181.
Conference Registration Deadline -- October 18, 2000.