Mail or FAX Registration - print this page
Registration must be completed by Friday, April 13, 2007
REGISTRATION
Asian American Forum Leadership Institute - April 21,2007
8:30 AM - 5:00 PM
University of Texas at Dallas
Mail
to: Asian American Forum, Inc.,
FAX to: 214-553-5944
Name
_________________________________
Title _________________________________
Organization
or School ___________________________
Address
_______________________________
City
____________ State ________
Zip ______
Phone
_____________ Email _____________
Individual Registration $50.00
By Friday, April 13, 2007
(includes
Morning Coffee and Lunch)
Student
Registration $25.00
By Friday, April 13, 2007
student ID required at the check in desk
(includes
Morning Coffee and Lunch)
Method of Payment - Amount $__________
Check Enclosed __________
or
Credit Card Information
___ Visa ___ MC ___AmEx
____________________ _______________ _________________
Credit Card Number Exp. Date 3 or 4 digit security code on back of card
______________________________
Name on Card
_________________________________
Authorized Signature
Mail
to: Asian
American Forum, Inc.,
9514
Hillview Drive -
Dallas TX 75231
FAX to: 214-553-5944