Paideia Group - REGISTRATION
Please print the form when completed and mail to: Paideia Program, Augsburg College, 2211 Riverside Ave., Minneapolis, MN 55454; attention: Anne Kaufman, CB #312 _____ My check, payable to Augsburg College - Paideia Program, is enclosed. _____ I wish to charge on my credit card. VISA or MasterCard # (circle one): _____________________________________ Expiration Date: _______________ Signature:____________________________________________________________ |
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| Augsburg Summer Paideia Institute | |
| Personal Information | |
| First/Last Name: | |
| Home Street Address: | |
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| State/Province: | |
| Zip/Postal Code: | |
| Country: | |
| School/Grade/Subject: | |
| Phone: | |
| E-mail: |
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| (Please note that this is a printable form only) | |