PACSCL GeoHistory Conference Registration

FUTURE FOUNDATIONS: Mapping the Past
Building the Philadelphia GeoHistory Network

Friday, December 2 and Saturday, December 3, 2005
Chemical Heritage Foundation, 315 Chestnut Street, Philadelphia

Applicant Information
Name
Title/Organization
Address
City
State/Province
Zip/Postal Code
Country
Phone
Fax
E-mail

Friday Breakout Sessions -- User Type
Please indicate your first and second choice

First Choice		Second Choice
	History		History
	Social sciences		Social sciences
	City/regional planning		City/regional planning
	Natural and environmental sciences		Natural and environmental sciences
	Tourism		Tourism
	Real estate development		Real estate development
	Architecture/landscape		Architecture/landscape
	Demographic		Demographic
	Medicine, epidemiology, public health		Medicine, epidemiology, public health
	Social services		Social services
	Public safety		Public safety
	Not attending		Not attending

Saturday Breakout Sessions -- professional affinity
Please indicate your first and second choice

First Choice		Second Choice
	Higher education or research institution		Higher education or research institution
	Government or publicly funded organization		Government or publicly funded organization
	Business and industry		Business and industry
	Not attending		Not attending

I will attend:
Friday only ($30) Saturday only ($30) Friday and Saturday ($45)

Student pricing:
Friday only ($15) Saturday only ($15) Friday and Saturday ($25)

Registration deadline: Monday, November 28
Cancellations received by Wednesday, November 23 will receive 90% refund. No refund will be made after November 23.

Questions? contact Laura Blanchard, Executive Director, PACSCL, 215-985-1445, lblanchard@pacscl.org