FBFSA CONFERENCE - MAY 19-21 1999
FAX / MAIL REGISTRATION FORM
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INSTRUCTIONS:
  1. Complete this form on the web

  2. Print this form
  1. Fax Registration Form to: 305-348-2086 -or-
    Mail this form with payment to:
    Florida International University
    Attn: Dr. Dominic Mohammed
    University Park - ZEB 350A
    Miami, FL 33199
FIU Advance Registration Fee:
    - $65.00 per person (after May 6, $80.00)
Outside FIU Registration Fee:
    - $75.00 per person (after May 6, $100.00) 		No. Attending:
Amount of Check:
SUS Account Transfer:
Organization:
Address:
City:   State:   Zip:
Telephone:   Extension:
Fax:   E-mail:
Attendees:




 Titles:
Please make check payable to:
FIU Black Employees Association

Mail to:
Florida International University
Attn: Dr. Dominic Mohammed
University Park - ZEB 350A
Miami, FL 33199 		Check the boxes below if...
you are attending the basketball game.
you are playing in the basketball game.
you are going to be on the cheering team.

For SUS Interdepartmental Transfers, use
Acct. #722000000
SUS Employees using Transfers, may
Fax Registration Form to: 305-348-2086

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