MALCA Conference

Wake Forest University

Winston-Salem, North Carolina

April 20-23, 2006

Illness, Madness and Criminality

in Austrian Literature and Culture

MALCA

German and Russian Department

P.O. Box 7353

Winston-Salem, NC 27109-7353

Conference Pre-registration Form

Print out, complete, and mail to above address by April 1, 2006

Attendee’s Last Name:

Attendee’s First Name:

Attendee’s Preferred Mailing Address:

Attendee’s Email Address:

Attendee’s Fax Number:

Multi-Media Requests for Your Presentation:

Conference payment

U.S. participants: $100 pre-registration fee before April 1, 2006. After April 1, $115. Must send check drawn from a U.S. bank. Please make checks payable to German and Russian Department, Wake Forest University. Include the name of the conference attendee on the check. Send to address above.

Based outside the U.S.: You may pay your $100 fee at the conference if you submit this form by April 1, 2006. At the conference, the fee will be payable in U.S. dollars or check drawn from a U.S. bank – no foreign currency can be accepted.

Note: All attendees must be members of MALCA. If you are not a member, please visit the MALCA website for membership forms and dues information.

Vegetarian food preferred: _______yes _______no

(Vegetarian food may contain eggs and dairy products.)