MAWSA 2004 Registration Form

___ I will be participating in the 2004 MAWSA Conference, “Women in Rural Communities: Maintaining Activism, Cultivating New Experiences, Advancing Scholarship.”

___ I would like to become a member of MAWSA. (Conference registrants can become members at no additional charge.)

PLEASE REGISTER NO LATER THAN DECEMBER 12, 2003. ALL REGISTRATION FEES ARE NON REFUNDABLE.  ALL PRESENTERS MUST PAY A REGISTRATION FEE.

Name: ________________________________________   

Mailing Address: ____________________________________________________________________

 Institutional Affiliation: ______________________________________________________

 Telephone Number: (____)_________________ Email Address: ________________________________

Member of N.W.S.A.?                       YES                         NO

 Title of Presentation/Paper: ___________________________________________________

Other Members on Panel: ____________________________________________________

AV Needs: __________________________________________________________________

Food Allergies: ______________________________________________________________

Special Needs: _______________________________________________________________

Enclosed Is My Check For ______$35.00 ______ $25.00 (STUDENT)

I will be paying with a credit card:
Card Type: ___________________ Number: ________________________________ Exp. Date: ________

MAKE CHECKS PAYABLE TO
“ THE MID-ATLANTIC WOMEN’S STUDIES ASSOCIATION”

Please send registration form and your check to:
Dr. Simona Hill
ATTN: MAWSA REGISTRATION
Department of Sociology and Anthropology
Susquehanna University
Selinsgrove, PA 17870