Envisioning PACC AmeriCorps VISTA Project Design Sessions

---------------------------------------------Section I: Registrant Information----------------------------------------------

*Date of Session Attending

*First Name:

*Last Name:

*Institution

*Position/Title

*Email:

*Address Line 1:

Address Line 2:

Address Line 3

*City:

*State:

*Zip Code:

*Phone Number:

Dietary Needs

If Other selected above, please describe:

Other Special Needs:

-------------------------------------------Section II: Payment Information-------------------------------------------

Please follow the instructions below to complete your registration.  We do not have the ability to accept electronic payments.   
    
Registration costs per person (includes lunch):    
    
$35 Per participant from Campus Compact member institutions    
$75 Per participant from Non-Campus Compact institutions     
    
Please send payment AND a copy of registration form (print this page)to:    
    
Pennsylvania Campus Compact    
28 South Dewberry Street, Box 8
Harrisburg, PA  17101
    
Checks can be made payable to Pennsylvania Campus Compact.  

Registration Deadline for the July 17th Session is June 28th.  
Cancellations made before June 28, 2013 will receive a refund of their registration.  
NO refunds will be made after June 28, 2013.  

Registration Deadline for the July 25th Session is July 3rd.
Cancellations made before July 3, 2013 will receive a refund of their registration.  
No refunds will be made after July 3, 2013.  
    
Questions regarding payment can be directed to Michele Lowrey    
at mlowrey@paccompact.org or 717-796-5072 ext. 1.

Final Confirmation

Prior to hitting the submit button below, please print this page for your records and include with your payment. 
 
Your registration is NOT complete until you hit the submit button.

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