Living the Future - Registration Form

YES! Please register me for Living the Future
Conference code: 61ULLIB214. Cost: $290

I am a full-time student. Please register me at the $100 student rate. My student ID# is:

Mr./Mrs./Ms./Dr.
Title
Institution/
Organization

Mailing Address
City State Zip
Country

Daytime Phone ( )
Evening Phone ( )
Fax ( )

E-mail

Important: Enter priority code # from mail panel (if you received a brochure by mail):
UA

Payment Information: Total Payment $

Purchase Order #
Organization
Credit Card: VISA Mastercard
Account Number Expiration Date
Amount to be charged $
Name of cardholder, if different from above:

If you have a disability and require accommodation, please contact us at the time of registration at 602-621-8632.

Cancellation policy: If you cancel your registration in writing before April 17 you will receive a refund less a $25 cancellation fee. Non-attendance does not constitute a cancellation.

© February 1996 Arizona Boeard of Regents

Note: conference fees are not tax deductible. Net proceeds will benefit the University of Arizona Library and Staff Endowment.

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