REGISTRATION FORM

 

Nathaniel Hawthorne Society Bicentennial Conference

Salem, Massachusetts, July 1–4, 2004

 

 

_______________________________________________________________________

            Last Name                             First                            Middle

 

_______________________________________________________________________

            Street Address

 

_______________________________________________________________________

            City                                         State                                        Zip Code

 

____________________________________________________________

                        Institutional Affiliation

 

Name of spouse or companion (if attending)___________________________

 

REGISTRATION—Regular: $90.00 ($50.00 for spouse  or companion)            $__________

Retired Persons & Graduate Students: $70.00

($50.00 for spouse or companion                                                $__________

$20.00 added to fees after June 15.  See enclosed

information sheets.

 

BREAKFASTS—$22.50 (only for those housed in Salem State

College dorms)                                                                                    $__________

 

BANQUET (July 3)—$30.00 per person (with registration)                          $__________

                                    $45.00 per person (without registration)                          $__________

            Please choose entrée preference:

            Chicken_____ Beef_____ Vegetarian_____

 

TOTAL  $______________

 

Registrants from outside the U.S. must send a check drawn on a U.S. bank and payable in U.S. dollars.

 

E-mail address for confirmation: _________________________________________

 

Please send this form and check payable to Nathaniel Hawthorne Society to

Frederick Newberry

Department of English

Duquesne University

Pittsburgh, PA 15282