Registration Form
Print and photocopy as needed.
Participant Information
___________________________________________
Full name
___________________________________________
Address___________________________________________
City; State; Zip
(_____)________________ (_____)_____________
Daytime telephone; Evening telephone
____________________________________________
Company Affiliaton________________________________
Email address
Payment method:
__ Personal check
__ Visa/Mastercard
__ Purchase order (PO must be attached):
__________________
Expiration Date
_____________________________________________
Card Number
_____________________________________________
Signature of cardholder<p>
To be sure that your record is accurate, please provide all the
information requested on the form.
For quick registration, telephone or fax registration is
recommended.
Please allow ten days for receipt of mailed registrations.
SDSU International Center for Communications
Professional Studies Fine Arts Rm 160
5500 Campanile Drive
San Diego, CA 92182-4522
Fax to:
(619) 594-4488 (24 hrs)