Registration Form
MODERN LANGUAGES CONFERENCE
SHIPPENSBURG UNIVERSITY, April 27th-29th 2012
Please print this registration form and mail with check payable to “Shippensburg University” to:
Shippensburg University Modern Languages Department Conference
Modern Languages Department, RLH111
Shippensburg University
Shippensburg PA 17257
Last name ___________________________________________________________
First name ___________________________________________________________
Department __________________________________________________________
E-mail address_________________________________________________________
Telephone ___________________________________________________________
Fax number ___________________________________________________________
Affiliation ____________________________________________________________
Address ____________________________________________________________
Registration Fee $80.00 ($50.00 for undergraduate students)
The registration fee includes the badge (required for admittance to the sessions), two lunches and a copy of the Conference Program. The meals will include vegetarian and non-dairy items.
________ I would like a vegetarian entrée
________ I would like a non-dairy entrée
Gala Dinner: Fee $25.00
________ I will be attending the dinner
________ I would like a vegetarian entrée
________ I would like a non-dairy entrée