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Registration Form International Perspectives on Student Affairs: Ireland Miami University and University of Vermont May 20 June 2, 2012

Please mail this form and your $300 deposit check made out to AAA as soon as possible to reserve your space to: Judy Rogers, Associate Dean, School of Education Health and Society 207 McGuffey Hall Miami University Oxford, OH 45056 This deposit holds your spot on the trip, and will be applied to the total cost.

Name (exactly as it appears on your passport):

Address:

Phone: Email: Passport Number (if you have one):

Please select an accommodations option: Double Room Single Room Any special needs we should be aware of - vegetarian, physical disability, etc

Please contact Judy with any questions: rogersjl@muohio.edu

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