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Registration Form

 

Crossing Boundaries: Europe Encounters New Worlds

 

An International Conference in Celebration of the Quincentenary of Cabral’s Voyage to Brazil

 

Coimbra, May 26-29, 1999

 

 

 

PLEASE TYPE OR PRINT

Name:______________________________________________________________________________________________

 

Mailing Address:____________________________________________________________________________________________

 

____________________________________________________________________________________________________

 

Institutional Affiliation:___________________________________________________________________________________________

 

Home Phone: ______________________________ Work Phone: ______________________________________

 

FAX: ____________________________________ E-mail: ___________________________________________

 

Paper Title: ____________________________________________________________________________________________________

 

____________________________________________________________________________________________________

 

Session Title (only for chairs, commentators, etc.):

____________________________________________________________________________________________________

 

____________________________________________________________________________________________________

 

 

REGISTRATION FEE:

Before February 1

_________ $100 (US)

_________ $70 for Mediterranean Studies Association members (only if you have paid 1999 dues)

_________ $40 for spouse or guest

 

After February 1

_________ $130 (US)

_________ $100 for Mediterranean Studies Association members (only if you have paid 1999 dues)

_________ $40 for spouse or guest

 

At the Conference

_________ $150 (US)

_________ $120 for Mediterranean Studies Association members (only if you have paid 1999 dues)

_________ $40 for spouse or guest

Registrants must pay in US dollars and are urged to use a US bank so as to avoid exorbitant bank fees.  Registrants who wish to pay with a check drawn on a foreign bank may do so, but must add $8 to the total to cover bank fees.

 

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You may pay by credit card:

Card type: VISA / MasterCard (circle one) Card number: __________________________ Expiration date: ___________

Name on card: _____________________________________ Signature: ________________________________________

 

AUDIO/VIDEO EQUIPMENT:

___________ No, I don't need any audio/video equipment.

___________ Yes, I need audio/video equipment.

 

Please provide me with the following equipment:

 

 

 

 

TOTAL PAYMENT DUE:

 

___________ Add the appropriate registration fees and enter amount here. Please make your check or money order (US $ only) payable to the Mediterranean Studies Association.  Mail this form with check or credit card information to Mediterranean Studies Association, Office of the Provost, University of Massachusetts, North Dartmouth, MA 02747-2300. You will receive a receipt. Pre-registration is required of all conference participants (i.e., those on the program). Individuals not participating directly in the conference may, however, choose to register on site.