Southern Historical Association

The Southern Historical Association
Preregistration Form

Preregistration forms must be received in SHA office by October 15, 2012. Any received after this date will be returned.

Name:

Last Name:

First Name:

MI:

Go By (if different):

Address:

Address 1:	Apt/ Box No.
City:	State:	Zip Code:
Country:

Institution (as you would like it to appear on your badge):

E-mail:

Spouse attending?

If yes, name please:

Field of Interest:

U.S. European Latin American Other

Membership:

SHA Member Affiliate Member Nonmember

Preregistration Fee:

Members $20.00
Nonmembers $50.00

Registration Fee at Meeting:

Members $25.00
Nonmembers $55.00

Student Registration Fee: $5.00

(NOTE: Spouses are registered free)

Number of Tickets:
Phi Alpha Theta Luncheon @ $25.00
European History Section Luncheon @ $25.00
Latin American & Caribbean Section Luncheon @ $25.00
Tour of USS Alabama Battleship @$17.00
Mobile Civil Rights Tour @$15.00