Conference Online Membership/Registration

Please fill out this form as completely as possible. You will receive a confirmation e-mail after your abstract has been sent. Information with an (*) is required.


 
Personal Information
 
* First Name: * Surname Name(s):
Gender:
 
Home Address
 
* Street / PO Box:
* City:
* State / Province:
* Zip:
* Country:
 
Mailing Address   ( if different )
 
My home address and mailing address are the same.
Street / PO Box:
City:
State / Provence:
Zip:
Country:

NOTE: For the Caribbeanist Directory, we will use the information from the membership form.

Please check here if you do not want your home address and phone number listed.

 
 
Telephone ( with country / area code )
 
* Home Phone: Work Phone:
* E-mail: Fax:
 
Institutional Affiliation   ( university, business, other )
 
Name:
Address:
Highest Degree:
Academic Discipline:
Where and When Degree Obtained:
 
Supplemental Information
 
Country of Birth:
Specific areas of interest in the Caribbean:
 
Membership Information

 

Both membership and registration are required of all presenters.

This is a one-year membership for individuals; it includes issues of the CSA Newsletter and is effective from May 2011 to May 2012.

Membership Type:

* Membership Fee:

Caribbean Basin Resident Membership (US $85)
Non-Caribbean Basin Resident Membership (US $160)
Student Membership (US $55)
Life-time Membership (US $0)
I do not wish to purchase a membership.

**Students must bring a valid copy of their student ID to the conference site in order to be eligible for the student rate
Conference Registration Information
 

Early registration rates effective until Friday May 27th, 2011
* Select a registration type:

Regular Member - US $125
Student Member - US $45 **
Regular Non-Member - US $200
Student Non-Member - US $65 **
I will not be attending.

**Students must bring a valid copy of their student ID to the conference site in order to be eligible for the student rate
Optional Contribution to the CSA travel grant:

Method of Payment
 
* Please specify your method of payment:

Credit Card / PayPal Account
Check
 
 
Please double check your information and click "submit" -