Continuing Studies Registration - TNGIC 2002
(Please print)

Name (first, last)_________________________________________________
Social Security Number (for CEU credits)______________________________
Address_______________________________________________________
City, State, Zip__________________________________________________
E-mail ________________________________________________________
Telephone (day)__________________ (home) __________________
Company name (if applicable)_______________________________________
Registration: (Registration for the Annual TNGIC Conference includes annual membership)
Conference Fee - $75 Student - $39
Select the workshop(s) you would like to attend:  
ArcGIS I ($250) Cartographic Principles ($50)
Intro to Imagine ($50) Introduction to Visual Basic & Map Objects ($100)
URISA Introduction to GIS ($75)
 
Membership renewal only, not attending meeting - $20
TOTAL Amount enclosed __________________________________
Number of posters to be entered in contest:  
PAYMENT INFORMATION
Mail check payable to MTSU to:
MTSU Division of Continuing Studies and Public Service
113 Cope Administration Bldg.
Murfreesboro, TN 37132
Mastercard     VISA Exp. ______________
Card no. ________________________________________________
Cardholder's name ________________________________________
Purchase order number _____________________________________
ATTN: _________________________________________________

SYSTEM REPORT INFORMATION

Sex Male   Female
Ethnic background:
White Black
Hispanic Asian or Pacific Islander
American Indian or Alaskan native Other _________________________
SPACE BELOW FOR UNIVERSITY USE
Receipt No. _____________________ Date _________________________
Amt. Rec. ______________________ Code ________________________
CA  CC   CK  CEU