REGISTRATION FOR FIFTH NATIVE AMERICAN SYMPOSIUM

Please Print or Type:

Name:___________________________________________________

Address:_________________________________________________

Phone:___________________________________________________

Professional: $45.00

Student: $30.00

Price includes registration, keynote dinner, and three Continental breakfasts.

Number of persons in party:__________________________________

Total enclosed:____________________________________________

Please enclose a check or money order made out to Southeastern Oklahoma State University and mail this form and your payment by Friday, Nov. 7, 2003 to:
Dr. Chad Litton
Dept. of Sociology, Box 4082
Southeastern Oklahoma State University
Durant, OK 74701-0609