USCSCA Conference Registration Form
8-10 June 2001

Name(s)________________________

Mailing address_______________________ 

Phone___________________

_______________________

E-mail address________________________

Rooms have been reserved at___________________________

If you have special dietary needs, please indicate them:
 ________________________________________________________________________

______________________________________________________________________

Registration fee ($30) is enclosed_____Yes_____No.

Exhibit space needed_____Yes_____No.

Please return to CubAmistad, P.O. Box 2201, Bloomington, IN 47402.