Last Name........................................................................................................

First Name........................................................................................................

Middle Initial....................................................................................................

Address (Street)...............................................................................................

City......................................................................................................................

State.....................................................................................................................

Zip........................................................................................................................

Home Phone.....................................................................................................

Work Phone.....................................................................................................

Cell Phone.........................................................................................................

Social Security Number..................................................................................

UF Student ID Number..................................................................................


I am enrolling in the Mazza Weekend Conference for:

º Non Credit

• $95 registration fee
• $25 dinner (optional)
  

º Undergraduate Credit

• $584     1 credit hour
• $1,168  2 credit hours
•  $25    dinner (optional)
  

º Graduate Credit

• $552 1 hour credit
• $1,104 2 hour credit
• $25 dinner (optional)

..............................................................................................................................




Make your check payable to the Mazza Museum

Please complete this form and a check and mail both to:

     Benjamin E. Sapp, Director
     Mazza Museum
     The University of Findlay
     1000 North Main Street
     Findlay, Ohio 45840-4560

For further information:

     email Benjamin E. Sapp at sapp@findlay.edu
     or call the Mazza Museum at 419-434-5521
     or FAX 419-434-6480


PLEASE REGISTER EARLY

• Space will only accomodate 300 participants.
• NO REFUNDS after November 1, 2009.
• There will be a $20 processing fee on all refunds.
• Refund checks will be issued after the Conference concludes.

Please note:

• Those who would rather pay with American Express, MasterCard or Discover by touchtone telephone may call the following toll free number: 1-866-546-7269.
• CASHNet@SmartPay will assess a service charge for the convenience of making credit card payments via telephone.
• The fee amount will be stated for review and acceptance before payment is processed.
• This service is for those taking the Conference for credit only.