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Luncheon Registration Form

Midwest Popular Culture Association Annual Conference
Friday-Sunday, October 8-10, 2004
Radisson Hotel-Gateway
651 Huron Rd., Cleveland OH 44115
216-377-9000, fax 216-377-9001
www.radisson.com/clevelandoh_gateway

Please return this form if you will be attending the Luncheon on Saturday, October 9, 12:00-1:30, in the Meeting House. This event includes a featured speaker and is free to conference registrants, but you must present a ticket. If you return this form, we will make you a ticket and give it to you at the Registration Desk. If you are not registering for the conference, you may still attend the Luncheon by sending us a check for $22, payable to Northern Illinois University. We must receive this form (and any payment due) by September 15, 2004.

Please list all people in your party who will be attending the Luncheon:

Cost per person is $22. Make check payable to Northern Illinois University. Return this form and check by September 15 to: Gary Burns, Executive Director Communication Northern Illinois University DeKalb IL 60115 Fax: 815-753-7109 Thank you!