Name:____________________________________________


Address:_________________________________________ 


_________________________________________________


_________________________________________________


Phone:  _________________________________________


Please Circle one:  Male  Female


I will arrive at (date)________  at  (time)____am/pm  
	
	and depart  (date)______________.


Room preference (Please circle one):  Smoking  Non-smoking 

Please fill out this form and return it by March 12th to:

Margaret Key, Language Pedagogy Project Coordinator
East Asian Studies Center, Indiana University
Memorial Hall West 207, Bloomington, IN 47405
phone (812) 855-3765 fax (812) 855-7762

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Document Revision: by easc@indiana.edu