REGISTRATION FORM

Conference Registration Fee is $100 and payment in full is required for on-line registration. Please print and complete the below form and mail to:

Nana Amos
Room 208, Wilbur Cross
233 Glenbrook Road
Storrs, CT 06269-4124
Phone: 860.486.0647

Name
Social Security Number
Address
City/State/Zip
Phone
Email Address
School information

Name
Address
City/State/Zip
Phone
Email Address
District Affiliation
I am O Famale  O Male
I plan to arrive on (date)
I plan to depart on (date)
I understand that unless I specifically request otherwise; any photograph(s) taken of me at the Institute may be used in print and electronic publications produced by the UNESCO Chair & Institute of Comparative Human Rights.

Signature/Date
Registration Deadline: Early registration is recommended. The deadline for registration is June 1, 2005; enrollment may be filled to capacity prior to that date.

Cancellations: For full refund, cancellations must be received by June 1, 2005. Persons who cancel after that date, or who register but do not attend, will forfeit their fee.

For registration questions, refunds, cancellations, participant substitutions, housing or payment questions, call the Professional Studies Office at 860-486-1052, or Fax: 860-486-5221.

For program content or special needs requirements, call the UNESCO Chair Office at 860-486-0647 or email unescochair@uconn.edu.

METHOD OF PAYMENT:
Payments may be made by check, money order, purchase order, or credit card. Make checks, money orders, or purchase orders payable to: University of Connecticut. A receipt of payment will be sent to you prior to the Institute or you can pick it up when you arrive. If you plan to use a Purchase Order to complete an online registration, you should contact UConn’s Professional Studies office at 1-888-869-0363 with a Purchase Order number and contact information.
O Check O Money Order Check Number
O MasterCard O VISA O Discover *Card #
Exp. Date
*Please indicate the amount you want to charge: $
O Third Party Payer (Name)
Signature
O Purchase Order / PO#
Contact Person Phone
Accommodations are available in the South Campus air-conditioned residence hall, which consists of quad suites. Single occupancy refers to two people sharing a suite (one person in each bedroom and two people sharing the bathroom). Rooms are assigned on a first come first served basis. All dorms on the UConn campus are nonsmoking, however, designated smoking areas are posted outside of the dorms. NOTE: Dorm accommodations are not available after check-out at 6:00 p.m. on June 30.

Registration fees include all costs of instruction, morning and afternoon refreshment breaks, and materials packet. All meals are provided with the exception of dinner on June 30. Package includes overnight accommodations on June 29.

Please return this completed form to: Nana Amos
Room 208, Wilbur Cross
233 Glenbrook Road
Storrs, CT 06269-4124
Phone: 860.486.0647