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SHROC VI REGISTRATION:

FEES

$25.00 - Standard
$10.00 - Disabled/Student/Limited Income
(Limited scholarships available-must apply by Oct. 22, 2006)


SEND THIS FORM TO:

Mississippi Workers' Center for Human Rights
SHROC VI
Registration
213 Main Street Greenville, MS 38701
Phone: 662-334-1122 instate
888-949-9754 toll free
Fax: 662-334-1274
E-mail:
workersrights@bellsouth.net

PAYMENT

Make checks/money orders payable to:
Mississippi Workers' Center for Human Rights (Memo: SHROC Vl)


LODGING
Holiday Inn Select 2712 Southwest Freeway, Houston, TX 77098
800-465-4329 (toll free),
713-523-8448 (in state)
$69.00 plus tax single/double occupancy room, per night - When Booking your room, say you are with
SHROC Vl
Reservation deadline: November 23, 2006


Name
Title
Affiliation
Address
City
State
Zip
Phone
Fax
E-mail

Primary Language

English Spanish Creole
FEES
Standard $25.00
Disabled/Student/
Limited Income
$10.00
   

I wish to attend the December 8th Youth Human Rights Summit