2-Day Multicultural Self Awareness Workshop

MSU Extension Registration

Required fields are indicated with an asterisk (*)

Registrant Information

* First Name

* Last Name

* Address

Addt'l Address

* City

* State

* Country

* Zipcode

* Phone Number

* E-mail If you supply an e-mail address, a receipt for your registration will automatically be sent to that account. An e-mail address is required to pay using a credit card.

Registration Information

* I would like to register for this event ($75.00)

Special Dietary Needs: If you indicate an allergy, please specify if it's ingested or airborne. Please provide as much information as possible about your restrictions so that we can appropriately meet your needs.

OPTIONAL: Lodging Information

Hotel costs are not part of the workshop fee and will need to be covered by your unit or individual budget. Contact your institute director or supervising educator if you have any additional questions.

Will you need lodging accommodations? * Yes No

Lodging Check-in Date (mm/dd/yyyy)

Lodging Check-out Date (mm/dd/yyyy)

Account number to charge for lodging

I understand that if I requested lodging, the account number provided will be charged. If no account number is provided, no lodging will be reserved.

Contact Information

For information, contact Imelda Galdamez at galdamez@msu.edu