2009 CAMP Higher Education Migrant Conference

Registration Form

Participant Information

Name:


First Name	MI	Last Name

Title:

Email Address:

Phone Number:

( ) -

Cellphone Number:

( ) -

Campus:

Campus Department:
(if applicable)

Contact Address:

City, State & Zip:

Best Time to Reach You:

From: To:

Conference Registration Fee Information

Registration Fee:

Registration Cost: $75.00 early bird rate by August 28, 2009

Registration Cost: $100.00 late registration rate

The cost of your registration covers conference materials, breakfast, lunch and an afternoon snack.

Payments for the conference should be made by check payable to CSU, Sacramento CAMP & mailed to:

Sac State CAMP
River Front Center 1
6000 J Street
Sacramento, CA 95819-6108
Attention: Dolores Ortiz

Registration Type:

Special Accommodations & Other Needs

Special Accommodations:

Dietary Needs: