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Gulf South Adult and Career Education Conference

March 6, 2009

Please print and mail this form to:

Department of Adult and Career Education
Attn: Pamela Lesane
Education Center
Valdosta State University
1500 N. Patterson St.
Valdosta, GA 31698-0800

First name
Middle initial
Last name
Title
School
School address
Address (cont.)
City
State
Zip/Postal code
County
Work Phone
Home Phone
FAX
E-mail

REGISTRATION

Early Registration:

$50.00

Includes continental breakfast and lunch at $17.00 per person.
(Payment must be received by 2/20/09)

Late Registration (after 2/20/09) &
On-Site Registration:

$65.00

No cash will be taken the day of registration --check or money accepted). (luncheon based on availability)

Number Attending:

 

Attach form for each participant.

Amount Enclosed:

    

PAYMENT METHOD

Check or money order made payable to: VALDOSTA STATE UNIVERSITY