REGISTRATION FORM

LIVING IN EXILE

CONFERENCE – OCTOBER 24-25, 2002

*****************************************************************

Please provide complete mailing information:

Name ___________________________________________________________

Department ______________________________________________________

Institution ________________________________________________________

City _________________________________ State ________Zip ___________

Phone: Office_________________________ Home ______________________

E-mail _______________________________ Fax ________________________

REGISTRATION FEE: Prior to October 1	$ 60.00
After October 1 and on-site registration at the Conference	$ 65.00
TOTAL PAID	$ _______

* Please make your check payable to J.M.U. "Living in Exile" Conference.