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Get 2013 Power In Diversity Conference Registration Form - Stcloudstate

Ome Phone Fax SSN (last 4 digits) SCSU Student ID Zip Code Birth Date (MM/DD/YYYY) The information on this form is private data, used to identify and locate you, obtain payment. Name, address, and payment method are mandatory. Early Registration Rates (10/01/12 - 4 pm on 12/14/13) $95 for MnSCU students Late Registration Rates (applies after 4 pm on 12/14/12) $105 for MnSCU students $120 for non MnSCU students $130 for non MnSCU students $155 for Advisors (non-student) $165 for Advisor.

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