ONLINE REGISTRATION FORM for RELIGIONS IN CONVERSATION CONFERENCE

Please provide the following contact information:

First Name
Last Name
Middle Initial
Title
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Home Phone
E-mail

Are you a member of the Claremont Colleges? [Yes No ]

If yes, which one?    (Student Staff Faculty )

(REGISTRATION FEE WAIVED FOR CLAREMONT CONSORTIUM MEMBERS)

Please Enter your Religious Affiliation in the space provided below.

Please choose your Preferred Scripture for the Conference:

The registration fee is $10.00 and payable on the day of the conference, or you may mail your payment to:

Religion and Culture
Claremont Graduate University
School of Religion
831 N. Dartmouth Ave
Claremont, CA 91711

PLEASE MAKE CHECKS PAYABLE TO "CGU"


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Revised: 04/01/07