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Civitas Middle East Conference Application Form
 

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Civitas United Nations  -  2003 Conference on Middle East

Friday/Saturday November 21-22, 2003

Application Form

Last Name:     First Name:

School:       Class of:

Home Address:

City:   State:   Zip Code:

Phone:   E-Mail:

Who would you like as your roommate(s)?

Do you need vegetarian meals?  Yes      No

Payment information:

The fee for this conference is $60.

Do you need financial aid in order to attend the conference?    Yes      No

 If so, please contact us, at 314-367-6480, or email to civitas@swbell.net.

 

Deadline for payment and enrollment: Friday, October 11, 2002   We accept personal checks, money orders or cash.

Make checks payable to Civitas Associates.

 

To be completely enrolled you need these 3 things:

1. Completed application form (above)                              2. Payment   

3. Permission form signed by parent or guardian with emergency information (MS Word format) (PDF format)

 

Civitas Associates
232 N. Kingshighway, # 2101
St. Louis, MO 63108 -4002
(314) 367-6480

For more information, call Civitas, 314-367-6480

                                       Or, email: civitas@swbell.net

                                      Or, go to our website:  www.civitas-stl.com