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* Name
* Dept/Discipline:
* Institution:
* Work Phone:
  Home Phone:
  Fax:
* E-mail:

For multiple person or group registration, enter a contact person
or group representative in the fields at left and the remaining
names, separated by a comma, in the space below:

* Select Event:
 

Teaching Institute
San Jose State University, San Jose, CA
August 13-15, 2008

$550 per person

Teaching Institute
University of Central Oklahoma, Edmond, OK

January 6-8, 2009

$550 per person

* Method of Payment:
  Please bill me. Use the following Purchase Order number:
  A check made payable to "Pacific Crest" is being sent to:

Pacific Crest
906 Lacey Avenue, Suite 211
Lisle, IL 60532

* Payment Amount:

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