Carnegie Classification for Community Engagement Workshop

Carnegie Classification for Community Engagement Workshop - 3/25/10

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

*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-------------------------------------------

We do not have the ability to accept electronic payments. Please follow the instructions below to complete your registration and submit payment by March 15, 2010. 
 
Registration costs per person (includes lunch): 
 
$10 Per participant from Campus Compact member institutions 
This workshop is for members ONLY.   
Participants can be from institutions that are members of any Campus Compact. 
 
Registration is limited to 80 participants and will be taken on a first-come, first served basis on paid registrations. 
 
Please send payment AND a copy of registration form (print this page) to: 
 
Pennsylvania Campus Compact 
Box 4508  
One College Avenue 
Grantham, PA 17027 
 
All checks must be received by March 15, 2010. Checks can be made payable to Pennsylvania Campus Compact. 
 
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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