The Indian Ocean: Cradle of Globalization
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APPLICATION FOR RESIDENCE
2002 NEH Summer Institute The Indian Ocean: Cradle of Globalization
UNIVERSITY OF PENNSYLVANIA
(Download Word file| Download .pdf file)

Please print clearly

 

Name (last, first, mi.): _______________________________________ E-mail: _______________________________________

Home Address: ____________________________________________ Fax Number: __________________________________

 

__________________________________________________________ Daytime Telephone ____________________________

__________________________________________________________ Evening Telephone ____________________________

I am interested in residence hall accommodations to arrive on: ________________ and depart on: ___________________

 

Sansom Place West

And would like to apply for:

 

Single Room with a shared bath ($145 per person per week) ______________

Private Apartment with one or two beds ($250 per apartment per week) ______________

Private bedroom in a shared double suite ($175 per person per week) ______________

 

List suitemate preferences, if any, under additional (up to 3):

Resident name: ______________________________________________

 

Additional: ______________________________________________

 

Additional: ______________________________________________

 

Additional: ______________________________________________

 

Method of Payment:

 

I authorize Penn to charge my University of Pennsylvania Bursar account (currently matriculated Penn students only).

 

My check/money order made payable to the Trustees of the University of Pennsylvania with my name and social security number printed on front, is attached.

 

I authorize Penn to charge my credit card. Visa MasterCard American Express

 

Card #__________________________ Exp.______ Name as it appears on card: ____________________________

 

Signature of card holder: ______________________________________ Please send photocopy of credit card.

 

* Please return this application and one weeks deposit by May 24, 2002 to:

University of Pennsylvania

Conference Services

222 Sansom Place East

3600 Chestnut Street

Philadelphia, PA 19104-6183

 

For more information, contact Christina Iliadis  at ciliadis@pobox.upenn.edu or (215) 573-8631