Name:

Address

ZIP

Affiliation/Organization

Telephone (day)

E-mail

Choose ONE Workshop: 1    2    3    4    5

Other special needs to be accommodated:

Check: Please make payable to Vincentian Center/St. John's University

Credit Card: Please indicate card type: MC / VISA / DISCOVER / AMEX

Please print clearly

Card Number:

Expiration date:

Name:

Signature of Cardholder

Address

Zip

Day Phone Number

[Credit Card orders may be faxed to 718 990-1901]

Space is limited! Register early!

CONFERENCE FEES

(Include materials, continental breakfast, lunch & refreshments)

INDIVIDUALS

$40 IF RECEIVED BY Oct. 1.2003

$45 AFTER Oct. 1, 2003

STUDENTS (ID Required)

$20 IF RECEIVED BY OCT. 1, 2003

$25 AFTER OCT. 1, 2003

Group Rate - five or more (must register as group, at the same time

$35 if received by Oct. 1, 2003

$40 after Oct. 1, 2003
 

COMPLETE *ONE* REGISTRATION FORM PER PERSON

[GROUP REGISTRATIONS, PLEASE ATTACH ALL REGISTRATIONS]

MAIL WITH YOUR CHECK PAYABLE TO:

VINCENTIAN CENTER.ST. JOHN'S UNIVERSITY

MAIL FORM AND CHECK TO:

VINCENTIAN CENTER FOR CHURCH AND SOCIETY

ST. JOHN'S UNIVERSITY

8000 UTOPIA PARKWAY

ST. VINCENT'S HALL - ROOM 108A

JAMAICA, NY 11439

Scholarships:

The Talbot Foundation will sponsor the first twenty-five (25) elementary/secondary schoolteachers, principals or superintendents who apply. [Submit registration form and fees. If you are one of the first twenty-five (25) to apply, you will receive your check back when you arrive at the Cnference.