Office of Multicultural Affairs

Black Issues Conference Form

13th Annual Black Issues Conference
Saturday February 11th, 2012
"It's Not Just a Black Issue: Politics, Leadership, Civil Rights"
Registration Form

Deadline for completed registration, including payment, is: February 3rd, 2012

Last Name:   First Name:

BGSU ID#:    Email:

Name of Institution:  

Mailing/Campus Address:  

City: State: Zip:


Please check the following: BGSU Student Faculty/Staff Non BGSU-Student Other

Please list any special accommodations that you may need:


Registration payment options:  You may choose to mail your registration payment (checks only) or pay at the registration desk on the day of the conference.
BGSU Students: $5.00
Non-BGSU Students: $15.00
Faculty/Staff/General Public: $15.00

Mailed payments must be received prior to the February 10th, 2012.  Checks should be made payable to: OMA- Black Issues Conference