REGISTRATION

Please print this out, fill it out, and fax it in to us or mail it in to us by Friday, September 5th, 1997, for Early-Bird Registration and save $15! If space is available, you may also register on Friday evening and Saturday morning at Fiesta Hall.

 

IGLE--COED Queer 2000 Registration Form

 

Name.........: __________________________________________________


Address......: __________________________________________________


               __________________________________________________


Phone number.: __________________________________________________


Email address: __________________________________________________

 

[ __ ] $75 Regular tuition

[ __ ] $60 Early-bird tuition
(must be postmarked by Sept. 5)

[ __ ] $35 Full-time student tuition.
(What school? ________________)

 

Payment method:

[ __ ] check or money order
(made out to "Friends of the Center"), or

[ __ ] MasterCard, or

[ __ ] VISA

__ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __   __ __ / __ __
card #                                                  exp. date   .


_____________________________________________________               .
(signature)                                                         .

 

Fax this to: (213) 461-5721, or

 

Mail it to:

COED -- Queer 2000
L.A. Gay & Lesbian Center
1625 N Schrader Blvd
Los Angeles CA 90028

 

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