Registrant’s Name

_______________________________________________________

Preferred Mailing Address

_______________________________________________________

Email Address

_______________________________________________________

Day Telephone

__________________

Evening Telephone

_________________

Institutional Affiliation

___________________________________________________

Please Note: In order to be included in the conference program, registration and payment must be received by March 30, 2007.

Faculty/Emeritus/Independent Scholar (circle one)

$50

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After March 30 and On-Site Registration:

$60

____

Student

$35

____

After March 30 and On-Site Registration:

$45

____

(All co-presenters must register for the conference)

Reservation must be made and payment received by March 30, 2007

$15

____

Membership Fee: Calendar year Jan-Dec 2007

All presenters must be members of IPA

Student

$5

____

Adjunct Faculty/Emeritus/Independent Scholar (circle one)

$10

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Full-time Faculty

$15

____

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Please check here if you are interested in presiding over a session.

Check or Money Order Payable to: Illinois Philological Association

Please return this form with your payment to:

Barbara Cass

MSUHB 4093

University of Illinois at Springfield

One University Plaza

Springfield, IL 62703-5407