KSU English Dept. > 2005 Cultural Studies Conference > Registration

VISUAL CULTURE: Pre-Registration

Department of English
108 ECS Building, Kansas State University
Manhattan, KS 66506-6501

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Return by January 15, 2005.

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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)............ $20
___ Faculty/Teacher (Non-KSU & Primary/Secondary Eduction).................... $50
___ Independent (Not affiliated with any educational institution) .................... $50
___ Graduate Student (Non-KSU affiliated)................................................. $20
Total Registration Fee: _______

Parking (No permit is required for Saturday)
General (___ Thursday $2) (___ Friday $2)
Reserved (___ Thursday $10) (___ Friday $10) -- Student Union lot
Total Parking Fee: _______

Equipment (provided at no charge)
(___TV/VCR) (___Slide projector/Screen) (___CD/Cassette Player) (___DVD Player)

Equipment (available for a fee)
(___laptop projector -- $15 fee)

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: Cultural Studies Conference 2005. Please keep a copy of this form for your records.