Registration Form

Registration Form

Faulkner and Morrison Conference
Center for Faulkner Studies
Southeast Missouri State University
Cape Girardeau, Missouri 63701
October 28-30, 2010

Name:  _______________________________________________________________

Postal Address:  _____________________________________________________________________________________________________________________________

E-Mail Address:  ________________________________________________________

Telephone:  ____________________________________________________________Academic Affilitation:  ____________________________________________________

Title of Presentation:  _____________________________________________________

Will you need a parking permit?   ________Yes       _________No

Special Equipment Request: _________________________________________________

Fees:

Registration fee ($90; $125 after August 1)                         ___________

Student Registration Fee ($60; $85 after August 1)             ___________

Banquet  ($15)                                                                   ___________

Historical Tour ($10)                                                          ___________

                                                            Total                     ___________

Mail this registration form with a check payable to Center for Faulkner Studies to:

Faulkner and Morrison Conference
Center for Faulkner Studies
Southeast Missouri State University
One University Plaza
Cape Girardeau, MO 63701