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 Initial
Address ___________________________________________________
Street Apt./Box No.
___________________________________________________________
City State Zip Code
E-mail address: ______________________________________________
Institution _________________________________________________
(as you would like it to appear on your badge)
Spouse attending________ if so, name please_____________________
Field of Interest: U.S.____ European____ Latin
American____ Other____
| Preregistration Fee |
Members $20 |
Nonmembers $50 |
| Registration Fee at Meeting |
Members $25 |
Nonmembers $55 |
| Student Registration Fee |
All Students $5 |
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| (Note: Spouses are registered free) |
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|
Phi Alpha Theta Luncheon |
______ @ $25 |
________ |
European History Section Luncheon |
|
________ |
Latin American & Caribbean Section Luncheon |
______ @ $25 |
________ |
Tour of USS Alabama Battleship |
______ @ $17 |
________ |
Mobile Civil Rights Tour |
______ @ $15 |
________ |
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| Check ______ |
Money Order _____ |
Total amount enclosed
_______ |
| SHA Member _____ |
Affiliate Member _____ |
Nonmember ______ |
1. Fill out information indicated. Local address
and room number should be supplied when you pick up your tickets
and badge at the PREREGISTRATION DESK.
2. Mail this page with check or money order.
Do not mail cash. Make all checks payable to Southern Historical
Association. All forms and checks should be sent to the Southern
Historical Association, History Department, LeConte Hall, University
of Georgia, Athens, GA 30602-1602.
MEMBERSHIP AND PREREGISTRATION FEES SHOULD NOT BE COMBINED IN A SINGLE CHECK; HOWEVER, BOTH CHECKS CAN BE MAILED TOGETHER.
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