Personal

Last Name

First Name

Preferred Name (for name tag/tent)

Title

E-mail

Date Of birth

TCLEOSE PID#
Gender:   Female     Male

Phone

Mailing Address

City

State

Zip
Class

Date and Cost:

Entomology: April 2 - 3, 2015
* * 10% discount if registered and paid by February 15, 2015
* * $300.00 regular registration must be registered and paid by April 1, 2015

Payment

I will be paying by:

    Online by Credit Card or Electronic Check
    Paper Check/Money Order                 Check #

Please make checks payable to SAM HOUSTON STATE UNIVERSITY and mail to:

College of Criminal Justice Attn: Kevin Derr
Sam Houston State University/CJC
Box 2296
Huntsville, Texas 77341-2296

Privacy Policy

For more information
Course Information: Dr. Joan Bytheway (936) 294-2310; bytheway@shsu.edu
Administrative Questions: Kevin Derr (936)294-1642; kevind@shsu.edu
Fax Number: (936) 294-1665