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Conference Registration

October 29-31, 2003

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You may submit this form by e-mail or fill out the mail-in version and send it to the MTSU Cultural Diversity Conference as indicated on that form.  Conference fees of $340.00 ($200.00 for students) may be paid with a Visa or Mastercard on-line by clicking this link or by mailing a check to:

Cultural Diversity Conference Registration
Box 139, MTSU
Murfreesboro, TN 37132

Please make out the check to "MTSU Cultural Diversity Conference"

Conference Registration

First Name: Last Name: Title:

Address: City:

State: Zip:

Telephone Numbers (day): (evening or cell):

E-mail (optional):

We would also appreciate the following demographic information:

Gender: Ethnic identification:

Person to contact in case of emergency:

Name: Relationship:

Address: City, State, and Zip:

Telephone Numbers (day): (evening or cell):

Lodging arrangements (please check one):

I have made reservations at the Sheraton Nashville Downtown (conference location):

I expect to make reservations at the Sheraton Nashville Downtown:

I will make other plans:

Any fees may be paid by check as described above.

You will receive a confimation that your e-mail registration is complete after submitting this form.