Phi Alpha Theta

Tennessee Regional Conference

February 25, 2005

 

Registration Form

 

Name _________________________________________________

 

Your Academic Institution _______________________________________

 

Student Classification (undergraduate, graduate) or Academic Title ______________________________

 

Mailing Address:    ______________________________________________

                             ______________________________________________

                             ______________________________________________

                             ______________________________________________

E-mail Address      ______________________________________________

Phone                             ______________________________________________

 

 

This form and a registration fee of $18 (checks made out to TTU) must reach us by January 22 (if you are presenting a paper) or February 12 (all others).  Please send this form and your fee to:

Dr. Susan Laningham

Tennessee Tech University

Department of History

Cookeville, TN  38505