Oklahoma City University

OCU : Honors Program

First Name :

MI:

Last Name:

Street Address:

City:

State:

Zip Code:

Home Phone:

Cell Phone:

E-mail:

College/University

Please indicate if you are:

Faculty

Student

Other

Faculty: If you are registering for your students, please indicate the total number of people attending, including yourself:

Please list the names of the students that will be attending:

CONFERENCE FEES	Price	Qty	Total
GPHC Member + Registration form and fee received by March 9, 2007	$55		$
GPHC Member + Registration form and fee received after March 9, 2007	$75		$
Non-GPHC Member + Registration form and fee received by March 9, 2007	$100		$
Non-GPHC Member + Registration form and fee received after March 9, 2007	$125		$ ____________
		TOTAL:	$

Transportation (check all that apply):

I am arriving in Oklahoma City by air

I am arriving in Oklahoma City by car or van.

I will need transportation to and from the OCU campus and to events during the conference.

If you are an Honors dean or director registering for students, please specify how many people in your group need ground transportation in Oklahoma City.

Specific Needs/Requirements/Comments:

Please make checks or money orders payable to: Oklahoma City University with "GPHC" on the check's memo line. Please mail your check or money order to:

Attn: GPHC - Virginia McCombs
OCU Honors Program
Oklahoma City University
2501 North Blackwelder
Oklahoma City, OK 73106-1493