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Center for Study
245 West 4th Avenue
Roselle, New Jersey 07203
=============================================================================== C O N F E R E N C E R E G I S T R A T I O N F O R M REQUIRED INFORMATION: Please answer the following questions: Your Name ____________________________________________ Your name as you would like it on your name tag (if different from above). __________________________________ Mailing Address _________________________________________ _______________________________________________________ Phone Number __________________________________________ Affiliation, organization ____________________________________ Do you have any special needs (such as limited mobility) that we should consider? Please note the conference facility is fully wheelchair accessible. _______________________________________________________________ Do you want to reserve an overnight bunk? (These are presentable, but somewhat public, accomodations at the conference site. See description under the Conference Information - Travel, lodging and meals section. There are 80 beds available on a first come, first served basis)Return to top of this pageThursday night ( ) Yes ( ) No Friday night ( ) Yes ( ) NoIf yes, please indicate the sleeping area you would prefer.( ) women only ( ) men only ( ) co-edOPTIONAL INFORMATION The following questions are optional. We ask them to help monitor our success in recruiting a multicultural and multidisciplinary group of conference attendees. Each question is open-ended. Please answer as you feel most appropriate. Current type of professional involvement and/or interest, e.g. sociologist, diversity consultant _______________________________________________________________ _______________________________________________________________ Age ___________________________________________________________ Race __________________________________________________________ Ethnicity _______________________________________________________ Gender _________________________________________________________ Social class _____________________________________________________ What are your expectations for the conference, and what will it take to make the conference a worthwhile experience for you? _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ ============================================================================