Late Modern Planet: Pre-registration Form

Department of English
Denison Hall, Kansas State University
Manhattan, KS 66506-0701

Return by February 11, 2002.
One registrant per form please.

Name: ___________________________________________________________________________________

E-mail Address: ________________________________________________________________________________

Affiliation (University, college, high school, etc.): _______________________________________________________

Paper Title (if presenting): __________________________________________________________________________________

_____________________________________________________________________________________________________

Mailing Address (please include street address, city, state, and zip code):

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

Contact Phone Number: ___ Office ___ Home (______) __________________________________________

Fax Number: ___ Office ___ Home (______) __________________________________________

Registration Category (mark one)
___ KSU Affiliate (KSU faculty member, alumni, employee, student)............ $15
___ Faculty/Teacher (Non-KSU & Primary/Secondary Eduction).................... $40
___ Independent (Not affiliated with any educational institution) .................... $40
___ Graduate Student (Non-KSU affiliated)................................................. $15
Total Registration Fee: _______

Parking (No permit is required for Saturday)
General (___ Thursday $1) (___ Friday $1)
Reserved (___ Thursday $2) (___ Friday $2) -- Lot D1 -- short walk from Student Union
Reserved (___ Thursday $6) (___ Friday $6) -- Student Union lot
Total Parking Fee: _______

Equipment (equipment provided at no charge)
(___TC/VCR) (___Slide projector/Screen) (___CD/Cassette Player) (___DVD Player) (___Other: ________________)

Method of Payment (please do not send cash)
___ Check # ___________ (please make check payable to: KSU Department of English)
___ Money Order
___ Will pay at Registration (all registration fees will be higher at the door)
Amount Enclosed: _______

Return this pre-registration form with your payment to the above address, ATTN: Symposium 2002. Please keep a copy of this form for your records.