S.E.T.A Registration form

            Name: ____________________

                 Address: ______________________

                    Phone #: ______________

                    E-mail ____________________________

                    Institution: _______________________

                    Please check one:

                                    Student        K-12 teacher        Faculty

                 Do you plan to present? _____________

                                               If yes, please include a brief description of presentation

                                                        Registration forms are due back by 

 December 15, 2001

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