Please print, fill out, and mail this form to:

Religion in the American South
Department of Religion
Emory University
Atlanta, GA 30322

Name_________________________________________


Address_______________________________________


               _______________________________________


State_____       Zip Code__________

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__ I will attend the Thursday evening dinner at a cost of $30 per person.

__ I will attend the Friday luncheon with Andrew Young.

__ I will attend the conference on the following days: Thu __ Fri __ Sat __

Registration fees: __ $75 (including continental breakfast and lunch on Friday and Saturday) __ $25 students

Please note that all fees are non-refundable

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I wish to pay by:

__Personal check (please enclose your personal check for the proper amount)

__ VISA

__ MASTERCARD


Total amount charged to my card: $_______


Credit card number_______________________________        Expiration date _______


Signature_____________________________________



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