Registration Form

REGISTRATION FORM

The Political Culture of The Revolt of the Netherlands, 1566-1648

October 7-8 , 2005– at the Clark Library

Registration Deadline: September 23
Registration fees: UC faculty & staff: $15; students with ID: no charge*; others: $30.
Please be aware that space at the Clark is limited and that registration closes when capacity is reached.
Fees are not refundable and apply to full or partial attendance.
Lunch and other refreshments are provided to all registrants.

Name _________________________________________________________________

Address________________________________________________________________

City. State, Zip Code_____________________________________________________

Phone number __________________________________________________________

Email address _________________________________________________________

UC status, UC department ________________________________________________

Number of persons _ Total Enclosed ____

Send this form, along with your check (payable to UC Regents), to the

UCLA Center for 17^th- & 18^th-Century Studies
310 Royce Hall
Box 951404
Los Angeles, California 90095-1404

[Campus mail code: 140403]

View the program for The Political Culture of The Revolt of the Netherlands, 1566-1648
Return to the Calendar of Events

REGISTRATION FORM

The Political Culture of The Revolt of the Netherlands, 1566-1648

October 7-8 , 2005– at the Clark Library

Name _________________________________________________________________

Address________________________________________________________________

City. State, Zip Code_____________________________________________________

Phone number __________________________________________________________

Email address _________________________________________________________

UC status, UC department ________________________________________________

Number of persons ___________________ Total Enclosed ______________________

Send this form, along with your check (payable to UC Regents), to the UCLA Center for 17th- & 18th-Century Studies 310 Royce Hall Box 951404 Los Angeles, California 90095-1404 [Campus mail code: 140403]

View the program for The Political Culture of The Revolt of the Netherlands, 1566-1648 Return to the Calendar of Events

Number of persons _ Total Enclosed ____

Send this form, along with your check (payable to UC Regents), to the

UCLA Center for 17^th- & 18^th-Century Studies
310 Royce Hall
Box 951404
Los Angeles, California 90095-1404

[Campus mail code: 140403]

View the program for The Political Culture of The Revolt of the Netherlands, 1566-1648
Return to the Calendar of Events