2002 SSHE-MA CONFERENCE
REGISTRATION FORM

NAME 
 
YOUR UNIVERSITY
 
MAILING ADDRESS
 
CITY
 
STATE
  ZIP
PHONE
 
E-MAIL
 
DAY & TIME of ARRIVAL on CAMPUS
    

FEES
CHECK ALL THAT APPLY

Faculty Registration
$35.00
First Timer Discount
–$10.00
Student Registration
$0.00
Late Fee
$5.00
Banquet
$15.00
Luncheon
$8.00
TOTAL

   

Make checks payable to SSHE-MA.
Please hold on to your check and give it to us at registration.

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