May 6 - May 8, 2005
Friday - Sunday
The University of Illinois
at Urbana-Champaign
 

Registration

Name
First Name:_______________________________________________________
Middle Name or Initial:______________________________________________
Last Name:_______________________________________________________
Affiliation:_________________________________________________________

Address
Street Name and Number_____________________________________________
City:______________________________________________________________
State:_____________________________________________________________
Country____________________________________________________________
Zip/ Postal Code:____________________________________________________

Home Phone:_______________
Work Phone:_______________
Fax: ______________________
E-mail:____________________

Registration fee: $50

WE ARE CHARGING A REGISTRATION FEE FOR THOSE IN ATTENDANCE WHO ARE NOT MEMBERS OF THE UNIVERSITY OF ILLINOIS OR SPEAKERS. THE FEE IS INTENDED TO HELP DEFRAY THE COSTS OF MEALS, REFRESHMENTS AND INCIDENTAL EXPENSES

Credit Card
Charge fee to:_____________
Card Number:_______________
Expiration Date:_____________

Check or Money Order . ______
Make payable to "University of Illinois". (All checks should be in U.S. dollars, drawn on U.S. banks.)

Please print out this form and mail or fax to

Ms Sally Eakin,
European Modernism Conference
Graduate School of Library and Information Science
University of Illinois at Urbana -Champaign
501 E. Daniel St
Champaign IL 61820
USA
Fax + 1 (217) 244 3302

Last update: March 9, 2005
Contact webmaster at welshons@uiuc.edu