What's the Big Idea? Fall 2009 Registration Form

Payment must accompany registration. Print out this form and mail or fax. Please print or type.

Name_____________________________________________________________________________

Mailing Address_____________________________________________________________________

City_________________________________________________State_______Zip________________

Daytime Phone (______)___________________________________

E-mail (please print clearly) ____________________________________________________________

UNC-Chapel Hill uses the Personal ID number (PID) to aid in keeping records for students and participants. If you already have a PID, please enter it. PID #__________________________________________________

If you do not already have a UNC PID, one will be assigned to you. Please provide the following information required for PID number creation:

Gender: M   F     Birth Date______________________________________________________

Are you an alumnus of UNC-Chapel Hill? Yes No. If yes, when did you graduate?_____________

Please indicate the accommodations and/or services you require to participate: __________________________________________________________________________________

Check the course(s) you wish to take.  The fee is $10 per course ($30 for all four).	Fee
To register for all four courses, check this box. The fee is $30.	$_________
Climate Change: Prospects for North Carolina Thursday, October 8, 7–9 pm. Course #2623	$_________
Public Policy and Planning for Climate Change Thursday, October 15, 7–9 pm. Course #2624	$_________
Climate Change and the Carolina Coast Thursday, October 29, 7–9 pm. Course #2625	$_________
The Energy Landscape: Options for the Future Thursday, November 5, 7–9 pm. Course #2626	$_________
Total enclosed:	$_________

Payment must accompany this form. Method of payment:

Check for $______ enclosed, payable to the Friday Center (Federal ID#56-6001393).

VISA or MasterCard (Only VISA and MasterCard are accepted. Debit cards requiring the use of a PIN for all transactions are not accepted.)

Mail or fax this form with payment to:
What's the Big Idea?
CB 1020, The Friday Center
UNC-Chapel Hill
Chapel Hill, NC 27599-1020
Fax: 919-962-5549