ELI Registration

Online

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Please direct Inquiries to Teriki Hicks (580-745-2268 or 800-716-0413)

First Name                     Last Name

E-mail              Level:    I     II

Title/Position     TRiO Program

School/Institution

Billing Information

Method of Payment Check      PO          PO Number

Contact Name Address

City State   Zip Code

Phone  Fax

Registration is $100.00 for all sessions.

Registration Deadline Sept. 4, 2009.

Amount Due

SPECIAL SERVICES REQUIRED (Requests must be received at least ten days
before the workshop.) Please give a brief description of your needs (vegetarian
meals, special assistance, special room accommodations, etc.)

Submit Payment to Francie Moss

Upward Bound

Oklahoma State University - Oklahoma City

900 N. Portland Ave.

Oklahoma City, OK 74701  580-945-8626

ODSA FEI Number 73-1086249