Pennsylvania German Society

and the

Society for German-American Studies

30 ^th Annual Symposium

May 4-7, 2006

Registration Form

First/M.I./Last Name

Name Badge

Title

Institution

Street Address

City/State/Zip Code

Country

Business Phone

Home Phone

Email Address

______  Check here if you agree that the information above may be included in the symposium participant list.

            List any items to be excluded:  ___________________________________________________________.

Check  all appropriate selections below:	PGS & SGAS Members	Non-members
Early registration fee (received by 4/1/06)	____   $40.00	____   $50.00
Late registration fee (received after 4/1/06)	____ $50.00	____  $60.00
On-site registration fee	____  $50.00	____  $60.00
Friday cocktail welcome reception	____  (Cash bar)	____  (Cash bar)
Friday PA German Banquet & Versammling	____  $30.00	____  $30.00
Saturday luncheon fee    Select one:   vegetarian lasagna   stuffed baked chicken   sliced London broil (also included in the price are a beverage, tossed salad,  taxes and gratuity)	____  $20.00	____  $20.00
Enter total amount enclosed	$	$

Make check payable to:    Pennsylvania German Society

_____ Please check here if you have special dietary needs or require additional accommodations. A representative will contact you.

Mail completed registration form and check to:        2006 Annual Conference

                                                                               Pennsylvania German Society

                                                                               212 S. White Oak Street

                                                                               P.O. Box 244

                                                                               Kutztown, PA 19530