Conflict Transformation Symposium Registration

University of North Florida

October4-6, 2007

(Required marked with asterisk *)

Personal Information:

*First Name:

M.I:

*Last Name:

Name as you would like it to be appear on Name Tag:

Your Organizational Affiliation:

Position or Title:

*Address:

*City:

*State:

*Zip Code

*Phone:

Alternate Phone:

*Email:

Special Needs

Registration Order

(A) REGULAR REGISTRATION: $130; (Early Bird discount: $110 if registered by August 31).

(B) LIMITED INCOME: $75; (Early Bird Discount: $65 if registered by August 31)

(D) Requesting Full Scholarship; (UNF Students Only);

If you are applying for a full scholarship to the Symposium, you are certifying that you

are currently enrolled as a student at the University of North Florida. If accepted, you

will be asked to volunteer in some capacity during the events of Peace Awareness Week.

(E) SATURDAY ONLY - $45 (Early Bird discount: $40 if registered by August 31) This option include all events of the Saturday program from 8:30am-2:30pm, including a Continental Breakfast and Luncheon;

Vendor / Exhibitor

My organization would like to be listed as a sponsoring vendor / exhibitor.

Click here for Vendor / Exhibitor Information

None
Gold Level ($500.00)
Silver Level ($300.00)
Bronze Level ($200.00)

Total Cost:

Payment Method

I will pay by credit card now

I will mail my check

Order Number: