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REGISTRATION FORM
Please print out, fill in and mail to:
Therese Champagne, MARIS coordinator
Dept. of History, LSU
224 Himes Hall
Baton Rouge, LA 70803
Name_________________________________
Affiliation_____________________________
Address_______________________________
______________________________________
Phone (____) _______________
email_______________________
Conference Registration $25____
Student registration $5____
Saturday luncheon $10____
Chicken___ Crawfish___
Total ____
Please make checks payable to LSU
Credit Card Payments
Type of Credit Card
_____VISA _____Mastercard
Card number__________________________
Expiration date_________________________
Total amount to be charged______________
Signature______________________________
Please send in by Sept. 10, 2003