Civil Rights Pilgrimage Sign Up

The trip sign up will open on October 5th and remain open until filled. Students will be served on a first come, first serve basis. A $75 deposit is required and should be made within 48 hours of the completion of this form to the Student Senate Office in Davies Center 132.

Cancellation of the trip after November 15, 2009 will result in a forfeiture of the deposit. Students registering for WMNS 222 will not need to pay the $350 fee. Instead a special course fee will be assessed on your university bill.

(ALL FIELDS MUST BE COMPLETED)

Full Name:
Address:
Email:
Phone:
Enrolling in WMNS 222:	Yes No
Requesting 15 hour Service-Learning Credit:	Yes No
Gender:	Male Female