Registration Begins for LeFrak Holocaust Education Conference 2009

Printable Registration Form

Name:  ________________________________________________

Position: _______________________________________________

Institution: ______________________________________________

Business Address:

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City: __________________ State:___      ZIP:  _________

Home Address:

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City: __________________ State:___      ZIP:  _________

Home Phone:  ________________________________________________

Work Phone:   ________________________________________________

E-mail address:  ______________________________________________

Yad Vashem Graduates:
Please provide year and season (summer, winter) of your seminar:

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Conference Fees Regular Payment
Sunday . . . . . . . . . . . . . . . . .$40 . . . . . . . . . . . . . . . . . . . . . . _______
Monday . . . . . . . . . . . . . . . . .$40 . . . . . . . . . . . . . . . . . . . . . . _______
Tuesday . . . . . . . . . . . . . . . . $40 . . . . . . . . . . . . . . . . . . . . . . _______

TOTAL AMOUNT DUE _______

Note: The fees above include lunches, two dinners and break refreshments.

Special services or meals required? ____ Yes ____No
If yes, please specify:

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PAYMENT ACCEPTED BY CREDIT CARD OR CHECK

Please make your check payable to The National Catholic Center for Holocaust Education.

To pay by credit card (please print clearly):

Type of card (check one):

___Visa ___Mastercard ___Discover ___American Express

Name as it appears on card:   __________________________________

Credit Card Number:              __________________________________

Expiration Date:                     __________________________________

Amount:                                __________________________________

Signature (required):               __________________________________

Mail form along with payment to:

The Ethel LeFrak Holocaust Education Conference
National Catholic Center for Holocaust Education
Seton Hill University
1 Seton Hill Drive
Greensburg, PA 15601-1599