NAARI Conference Registration
First Name
Last Name
Organization Name
Street Address
City
State
Zip
Country
Phone
Website
E-Mail
Registration Categories	Corporate/Government - Advance $125, on site $ 175 Small Business/Non-Profit -Advance $75, on site $100 Singles - Advance $35, on site $45 Couples - Advance $50, on site $60 Student/Low Income - Advance $15, on site $20 (Must show student ID or proof of income at the registration desk)
Payment Information
Payment Type	Visa MasterCard Check
Card Number
Expiration Date
Signature( required for credit card)

Note : Please fill out the information bove and send your payment to:

Dr. Patricia Dixon
National African American Relationships Institute(NAARI)
Department of African American Studies
Georgia State University
P.O. Box 4109
Atlanta, GA 30302-4109
1-877-831-5258