International Thomas Merton Society

Bellarmine University

ITMS Conference Registration Form:

        Name:        __________________________________________________________________

        Address:    __________________________________________________________________

        City:            __________________________State, Zip:   ______________________________

        Phone:         ___________________        Email: ____________________________________

Registration Fees for the conference and all meals:
                □ ITMS Member - $200.00

                □ Non-Member - $250.00

                □ I prefer vegetarian meals.

$_________

Accommodation:
                □ $150.00 (for three nights - per person)

 $_________

Additional Lodging Fee:
                □ Wednesday, June 6 - $55.00 (no meals)
                □ Sunday, June 10 - $55.00 (no meals)

 $_________

Group Tour: Civil Rights Museum:
Visit to the National Civil Rights Museum is available on Thursday, 12 noon, June 7, for a charge of $10.00 to include transportation and entry ticket.
                □ Tour of Civil Rights Museum - $10.00

 $_________

Daggy Scholarship Fund:
 Would you like to make a donation to the Daggy Youth Scholars Fund?
 Donations to the Daggy Scholarship Fund are tax deductible to the extent allowed by law.

 $_________

Total
(made payable to ITMS):  

$_________

Please print and return this form, with check or money order made out to ITMS, to:
Gray Matthews.
Dept. of Communication - TC143,
University of Memphis,
Memphis, TN. 38152.