Humboldt State University

SOCIAL JUSTICE SUMMIT
March 6 & 7, 2015

REGISTRATION FORM

NOTE TO HSU STUDENTS: You must register by Feb. 16 through HSU WEB REGISTER, and should not use this form.

ALL OTHER PARTICIPANTS: DEADLINE to pre-register: 5 p.m., Monday, March 2.

After March 3, register on-site in the HSU University Center on
Friday, March 6, 3-6 p.m. or on Sat., March 7, beginning at 9 a.m.

If you are using a PURCHASE ORDER or CHECK: Do not use this form.
Please download and print PDF registration form, attach your P.O. or check,
and mail to eLearning & Extended Education (see below for address).

If you do not wish to use this on-line registration form, or if you are having trouble with it,
you may call in your registration: 707-826-3731, Mon.-Fri., 8 a.m.-5 p.m.
(VISA/MC/Discover)

You may also use the downloadable form (PDF).
[PDFs require Adobe Reader.] Fill out the form and mail it to the address below,
or bring it with your payment to the College of eLearning & Extended Education,
second floor of the Student Business Services building, Mon.-Fri., 8 a.m.-5 p.m.

Mailing address:
Social Justice Summit
College of eLearning & Extended Education

Humboldt State University
1 Harpst St.
Arcata, CA 95521-8299


phone   707-826-3731 • e-mail extended@humboldt.edu


* = Required field

PARTICIPANT Information


Please answer the following:

Male    Female
YES     NO
YES     NO
List all names you have used at HSU. (Examples: Birth Name, Maiden, Previous Marriage, Legal Name Change)
  -    - 
To identify your HSU record, we require you to enter your date of birth:*                      

SOCIAL JUSTICE SUMMIT REGISTRATION

Select one registration category. *
If you are registering for credit, also select an option under "Conference Credit - Academic Credit"

$25 $
$25 $
$25 $
$20 $
$25 $
FREE $
FREE $

FREE $
FREE $

OPTIONAL ACADEMIC CREDIT

Academic credit is optional. If you want academic credit, choose one of the courses that appear below.

NOTE: HSU students must register by Feb. 16 through HSU web register, and should not use this form.

Ethnic Studies: ES 480: 1 unit (21260)
$232 $
Women's Studies: WS 480: 1 unit (21082) $232 $
TOTAL REGISTRATION COST
$

Please review the above information for accuracy before submitting this registration form.
If form will not submit, you'll need to review that all the required information is entered above.
Missing information will be marked.

Fee payment is through the CashNet system, to which you will be directed upon submission of this form.