Registration Form for the 29th Annual Colloquium

Registration Form For the 29th Annual Colloquium
65 years of Bearing Witness: Our Commitment to Human Rights
Wednesday, May 12, 2010; 9:15 AM- 12:30 PM

Please complete all information legibly.

Name (Last)______________________________ (First) _________________________

Address_____________________________________________________________________

City_________________________________State___________Zip____________________

Phone (Home)_____________________ (Cell)__________________________

Email Address______________________________________

Please email my information (Y/N)______

If you are a teacher, School Name_______________________________________

School Address_______________________________________________ School phone________________

School City__________________________State_____________Zip________________

If you are bringing students: Grade___________________

# of Attendees__________________@ $5.00/person   Total fee______________________

Payment by Check _ Payment by Purchase Order#__________________
Check should be payable to: BCC/OBCD

Mail to:

Holocaust, Genocide & Human Rights Education Center
at Brookdale Community College
765 Newman Springs Road
Lincroft, NJ 07738
Email form to: holo-center@brookdalecc.edu
Fax to: 732 224-2045             NEED MORE INFORMATION: 732 224-1889

Payment or purchase order must be received to guarantee your registration and receive your workshop assignments.

REFUND POLICY
Cancellations before April13, 2010 will receive full refund.
No Refunds after April 13, 2010.