REGISTRATION FORM

Cross and Culture in Anglo-Saxon England

Feel free to copy this form for additional registrations
Please print or type.

Name: _________________________________________________
		Last			First			M.I. (optional)
Affiliation:___________________________________________

Mailing Address: _______________________________________

State: _____________________ Zip/Postal Code: _______ Country:____________

Email:______________    Phone:  __________________       _____________
					business		fax
Request disability access: _____
Request parking permit: ______  (free, but no guaranteed spaces)

Please check which nights you would like bed and breakfast at St. John's College 
and which additional meals.  
____Thursday 2 August	($32)	                         ____dinner ($13)
____Friday 3 August ($32)		____lunch ($12)		____dinner ($13)
____Saturday 4 August	($32)		____box lunch ($10)

				Dietary restrictions:_______________________________

Total nights and meals:  $_____
Registration fee:        $_____  [$65 if postmarked by June 30; 
				  $75 if received after July 10]
TOTAL ENCLOSED:          $_____
Form of payment:
__ 	Check made payable to the University of Hawaii
__	I hereby authorize University of Hawai‘i the use of my credit card account: 
 __ VISA  ___ MasterCard    Expir. date (Mo/Yr) ____

	Credit Card No._______________________________________
	Signature ___________________________________________

Send registration form and payment to: 
UH Conference Center; 2530 Dole St., Sakamaki, C404; Honolulu, HI  96822
UH Conference Center at (808) 956-8204.   Fax. No. (808) 956-3364  

UHCC I.D. #C04127