(You are encouraged to make copies of this form for interested colleagues.)

CONFERENCE REGISTRATION FORM
PTO 10TH ANNUAL CONFERENCE
Omaha, Nebraska USA
MAIN CONFERENCE: APRIL 22-24, 2004; BOAL WORKSHOPS: APRIL 18-21, 2004

Please clearly print all information. Use a separate form for each registrant.

Name: _________________________________________________________________________________________
		Last					First

Name you want to appear on your name badge: _________________________________________________________

Mailing address: _________________________________________________________________________________
	(Students: Please use your home address)		Street/Apartment

__________________________________________   _____________________    ________________________    __________________________
City			     State/Province		Zip/Postal Code	    	Country

Telephone  (home) ______________________________     (work) ________________________________

email _________________________________________________________________________________

REGISTRATION FEES
(Check all that apply; write amount in right column.
Please send ONE payment for total.)	PAYMENT:

Make check or money order (US currency only) payable to:

Pedagogy & Theatre
of the Oppressed.

Mail to

Pedagogy & Theatre of the Oppressed
P.O. Box 31623
Omaha, NE 68131-0623

Sorry, no credit cards or purchase orders.

Questions? Call or e-mail us.

For registration questions, e-mail Carol Lloyd (Treasurer/On-Site Chair): 
clloyd@mail.unomaha.edu
402-554-3471

For specific questions about Boal workshops, contact Doug Paterson
dpaterson@mail.unomaha.edu
402-554-2422	
THEATRE OF THE OPPRESSED WORKSHOPS: 	Fee:	Your cost:		
 Boal 3-day Forum Theatre Workshop – April 18 – 20 (Sunday – Tuesday) (limited enrollment)	$395			
 Boal 1-day Introduction to Theatre of the Oppressed workshop – April 21 (Wednesday) (limited enrollment)	160			
2004 PTO MEMBERSHIP: (To check your membership status, go to our website.)		
 General Membership	$30			
 Student Membership	15			
PTO CONFERENCE REGISTRATION:
April 22 – 24 (Thursday – Saturday) 
(NOTE: You must be a member for 2004 to receive membership discount.)	Received by April 1	Received after April 1			
 PTO Member: General 	$130	$150			
 PTO Member: Student	55	75			
 Non-member: General	165	185			
 Non-member: Student *	75	95			
TOTAL			
*Note: K-12 students who are part of your presentation will not be charged a conference registration fee.  A $5.00 donation per student is requested.  This applies only to the conference, not to workshops.