Title Employer/School

Mailing Address

City State Zip Code

Home Phone

Work Phone

E-mail Address

Number of guests to accompany me

I will require overnight accomodations

What day(s) will you be attending?

Thursday Evening

Friday Morning
Friday Evening
Saturday Morning
Saturday Afternoon

For more information about the Forum,
contact Stephanie Hill.
phone: (512) 471-0801.
fax: (512) 471-8455
Barbara Jordan Memorial Forum
c/o Office of Student and Alumni Programs
Lyndon B. Johnson School of Public Affairs
University of Texas at Austin
P.O. Box Y
Austin, TX 78713-8925

Please complete the registration form by February 11, 2000