Sunday, June 24th - Saturday, June 30th, 2012 Case Western Reserve University, Cleveland, Ohio
First Name: Last Name:
Street Address:
City: State: Zip: Country:
Phone Number: Email:
Name of preferred suite mate(s) (if any):
Will you bring a spouse/guest? 2 people in one room (one double bed ) You will need to pay an additional $150 board for this person. A registering guest/spouse should fill out a separate registration for tuition only. Yes No
Do you have any special needs that require special arrangements?
Will you be arriving a day early or staying an extra night? An extra night (no meals) will be charged at $60.00 per person per night.
Do you wish to pay for on-campus parking? (one payment of $40 for the week) Yes No
Please Note: Your registration is not complete until your check is received by Garald Farnham, 255 W. 98th, Apt. 5C, New York NY 10025. For payment questions, please contact Garald at gfminstrel@nyc.rr.com.
If you do not receive an email confirmation within 2 weeks of submitting this online form, please contact the Director (Phil Rukavina, info@philliprukavina.com). Thank you!
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