Registration Form: Presenter/Attendee

Conference on Current Pagan Studies
Online Registration Form
January 28 & 29, 2017
Name
Prefix

First

Last

Suffix

Institution or Independent Scholar

Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country

Phone (Day)

###

###

####
Phone (evening)

###

###

####
Email

TITLE of your proposal

 I am participating but not presenting 
YOUR A.V. NEEDS
Every attempt will be made to accommodate specific requests, but we cannot guarantee to meet all needs. Equipment requests not included on this form may not be accommodated.
 VCR/ Monitor 
 Overhead
Projector 
 Slide
Projector 
 PowerPoint 
 Other:  
Fees: Includes Coffee and pastries at Registration , Conference & Lunch
Claremont Consortium Students: $15 ($10 for Early Bird)
Students: $45
Professors: $70
Others: $55
$10 Discount for Early Bird (other than CC students) – Ends November 5,2016
SAVE MONEY & GREEN THE CONFERENCE-
Bring Coffee cup- Reduce fee by $2.50
Bring Plate- Reduce fee by $2.50
Bring Both- Reduce fee by $5.00
Please use paypal button on Registration main page to pay fees.

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