M S A - Y A L E C O L L E G E

Muslim Students' Association - Yale College

Critical Islamic Reflections

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In the Name of Allah, Most Gracious, Most Merciful

Online Registration Form

**Please note near the bottom the change in conference fees if registering after March 28th.

The day program is available again for a limited number of spots - hurry! Night only registration is also still available.

Name:

Organization/School:

Title (if any):

Address:

City:

State:

Zip Code:

Phone Number (include area code):

E-mail Address:

Comments, Questions, Suggestions:

Registration Fees:
Day and Night program:
   After March 28th: $30 pre-registration (Mail or PayPal)
   $35 at the door
Night program only:
   Before March 28th $10 pre-registration (Mail or PayPal)
   After March 28th $15 pre-registration (Mail or PayPal)
   $15 at the door

Make checks payable to:
Muslim Students Association at Yale College
P.O. Box 202217
New Haven, CT 06520

Programs desired (please complete the number field with the number of people you are paying for; leave a zero if not paying for that program).

I am paying for the day and night registration of person(s) (include yourself if attending both day and night). (For each add'l person, add $30 if pre-registering [mail/ PayPal] or $35 if paying at the door)

I am paying for the night ONLY registration of person(s)
(include yourself if attending both night ONLY). (For each add'l person, add $15 if pre-registering [mail/ PayPal] or $15 if paying at the door)

Methods of Payment (please choose only one method per registration form).

I will mail in a check for the conference registration fee(s) by April 10, 2002.
I will pay the onsite conference registration fee(s) when I arrive on the day of the conference.
I will pay the fee(s) using a credit card via secure, fast PayPal (To pay with PayPal, first complete this form and click REGISTER below).

I will be using a car to to get to the conference.
I will need accomodations during the conference.