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Registration Form
JSA Professional Development Workshop
"Japan's Cultural Pivots"
June 12-22, 2019
Community College of Philadelphia
University of Pennsylvania's Center for East Asian Studies
Registration deadline: 30 April 2019
Participant Information
*
Indicates required field
1. Name
*
First
Last
2. Institution
*
3. Academic position
*
4. Academic discipline
*
5. Professional (institutional) address
*
Line 1
Line 2
City
State
Zip Code
Country
6. Work phone
*
7. Cell phone
*
8. Preferred e-mail (shared with workshop participants)
*
Logistics
The $100 registration fee includes:
Workshop participants are responsible for their own hotel reservations. JSA has negotiated
9. Payment (please choose one)
*
I will make the registration payment myself online
My institution will make the registration payment online
I will pay the registration fee by check
My institution will pay the registration fee by check
10. Lunch, Thursday, October 4
*
Turkey Sandwich
Vegetarian Sandwich
11. Lunch, Friday, October 5
*
Chicken Salad
Vegetarian Salad
12. Dinner, Friday, October 5
*
Salmon
Vegetarian Entree
13. Food allergy or intolerance:
*
No
Yes
Please specify
*
14. How did you find out about this Workshop?
*
15. Any comments?
*
Registration payment by check
If payment by check is your preferred option, please complete this registration form, print it out and mail it to Prof. Stacia Bensyl together with your check to the following address:
Stacia Bensyl
Professor of English and JSA Treasurer
Department of English, Eder Hall 222-I
Missouri Western State University
St Joseph, MO 64507
Alternatively, complete the registration form, save it as a Word Document and e-mail it to Prof. Bensyl at
bensyl@missouriwestern.edu
. Please indicate in your e-mail the date on which you have mailed your registration fee.
A receipt of payment and confirmation of registration will be issued once we have received both your payment and registration.
Submit registration form