Registration Form

Combating Sex Trafficking: Prevention and Intervention in North Carolina and Worldwide
April 3-4 , 2008

Payment must accompany registration.

Name_____________________________________________________________________________

Mailing Address_____________________________________________________________________

City_________________________________________________State_______Zip________________

Daytime Phone (______)______________________________________________________________

E-mail (please print clearly) ____________________________________________________________

UNC-Chapel Hill uses the Personal ID number (PID) to aid in keeping records for students and participants. If you already have a PID, please enter it.

PID #______________________________________________________________________________

If you do not already have a UNC PID, one will be assigned to you. Please provide the following information required for PID number creation:

Gender: M____ F____ Birth Date_________________________________________________________

You may register for Thursday only, Friday only, or both days:

Payment must accompany this form. Method of payment:

___ Check enclosed, payable to the Friday Center (Federal ID#56-6001393).

___ VISA or ___ MasterCard (Credit card may be received by mail, fax, or phone.)

Mail or fax this form with payment to:

Combating Sex Trafficking
Professional Development and Enrichment Programs
CB 1020, The Friday Center
UNC-Chapel Hill
Chapel Hill, NC 27599-1020
Fax: 919-962-5549. Phone: 800-845-8640 or 919-962-2643                                    #2425