SYMPOSIUM ON TEACHING CONSECUTIVE INTERPRETING June 12-14, 2005 PLEASE PRINT OR TYPE

 

NAME:                                                                                                                                  

 

ADDRESS:                                                                                                                            

                                                Street number                             Street Name

                                                                                                                                               

                                                City                                          State                             Zipcode

                                                                                                                                               

                                                Country                                                                                    

PHONE:         (           )                                               V                                             TTY   

 

FAX:               (           )                                                                                                          

E-MAIL:                                                                                                                                

 

PROGRAM AFFILIATION (if applicable):                                                                           

 

POSITION:                                                                                                                           

 

Please indicate your language pair(s):                                                                        

 

Enclosed is my payment of $_________ (US dollars only) payable to WOU-RRCD

Check #                      

Money Order #                                  

 

Credit Card (circle one):         Visa                 Master Card

Number #                                                                                Expiration Date                      

Name on Card                                                                         Vcode                                     

Signature                                                                                 (3 digits on back of card)

 

Mail registration and payment to:

Region X Interpreter Education Center, Symposium on Teaching CI,

Western Oregon University, 345 N. Monmouth Ave. RRCD, Monmouth, OR 97361