The Sixth Annual Disability Symposium
University of Pennsylvania
Friday, March 30, 2007

Schedule / Travel and Accommodations /
Workshops / Plenary Speakers / Symposium Main Page

Registration Form
Deadline for Registration - March 23, 2007

(Click here for a Word version of this form)

Please! Type or print CLEARLY

Name:__________________________________________________________________

Organization:_____________________________________________________________

Mailing Address:________________________________________________________________

City: ________________________ State: _______________

Zip/Postal Code: ______________

Work Phone: ______________________________

Work Fax: ________________________________

E-Mail Address:________________________________________________________________

The registration fee of $50.00 includes continental breakfast, buffet
lunch, and afternoon snack.

Please make checks payable to “Trustees of the University of Pennsylvania”

Checks will be accepted at the time of the event, but please register as early as possible.

Exempt from registration fee (please check if applicable):
_______Student
_______Penn faculty or staff member

Mail Registration Form to:

Weingarten Learning Resources Center
3702 Spruce Street, Suite 300
Philadelphia, PA 19104
ATTN: Symposium Chair

or Fax: 215-746-6326

Workshop Choices:

Please circle one choice for each Session. Requests will be honored on a first-come, first-serve basis.

Morning Session: A B C D ï choose only one from this line

Afternoon Session: E F G H ï choose only one from this line

 

Disability Accommodations:
Please indicate if you require disability accommodations:

 

Dietary Restrictions:
So that we may accommodate your needs, please note any dietary restrictions: