Registrant Information

Student ID Number:

Name (first, last):

Address (street or box):

City, State, Zip:

Home Telephone:

Birthdate:

Female Male

E-mail address:

SPECIAL NOTE: We want this program be accessible to all who wish to attend. Should you have a special need, please specify here:

Payment Information

Architecture Camp 2009 cost is $

Visa MasterCard Check Money Order

If paying with credit card, complete the following:

Cardholder's Name:

Expiration Date (month/year):

Card Number:

Amount to be billed:

Signature:

If paying by check or money order, please forward completed registration form and payment of $ to:

Architecture Camp 2009
Auburn University
Outreach Program Office
301 O.D. Smith Hall
Auburn, AL 36849

** NOTE: All checks or money orders should be made payable to ‘Auburn University'.

You also may call us at (334) 844-5100 or fax your registration to (334) 844-3101.