(November 16 - 19, 2008) Registration Form
Today's Date (mm/dd/yy):
Student's Last Name:
Student's First Name:
Student's Email Address:

Please check appropriate option:

Current Principia College student: mailbox # Phone Ext:
Expected year of graduation: 2009 | 2010 | 2011 | Other  
Current student at (college/university)
Expected year of graduation: 2009 | 2010 | 2011 | Other  
Principia alumni, class of: 2004 | 2005 | 2006 | 2007 | 2008 | Other  
Other college/university alumni.
School
class of: 2004 | 2005 | 2006 | 2007 | 2008 | Other  
If NOT current Principia College student:
Street Address
City State ZIP
Phone
Academic Major(s):
 Academic Minor(s):

Registration Fee: (please check one)

$109 Principia Student Early Rate
(expires October 15, 2008)
$135 Principia Student Regular Rate
$199 Alumni/Non-Principia Rate

Note: Fee includes all conference materials, meals (Sun evening - Wed), and dorm housing (Sun - Wed nights)

Payment: (please check one)

Please bill my Principia student Account
#P01-
(current Principia students only)
Please charge my credit card:*
Visa | Master Card

Acct. No:_______________________

Exp. Date:_______________________
*Note: Please print and FAX or postal mail if credit card payment is used.
Check enclosed (payable to "Principia - ACA")
(Please print form, and mail it with your check.)

Signature (required if using a credit card, and you're printing this and FAX or mailing it):

 

To mail or FAX your form, or for more information:

Jim Brandt, Career Coordinator
Principia College
100 Maybeck Place
Elsah, IL 62028
618-374-5775
FAX 618-374-5773