TRACS 
Pre-Applicant/Applicant Workshop
 Grace Baptist Temple, Room#21
Winston-Salem, NC 
June 3, 2008

Complete the following blanks and Submit below
Online Registration does not include Hotel lodging costs.

Enter the following information
Institution Name:
Mailing Address:
City, State, Zip:
Email Address:
Phone Number:
Fax Number:

REGISTRATION FEES:

First Registrant Per Institution:  $150.00
Each Additional Registrant:  $150.00

Enter each Registrant Name and Title (to Appear on Badge)
Type one Name and Title per line

Enter Total Registration Fees
Registration Category Quantity Price Total
First Registrant Per Institution
Each Additional Registrant
 
 
  GRAND TOTAL

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