Paideia Group
Paideia Group
Summer Institute 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:____________________________________________________________
| Augsburg Summer Paideia Institute | |
| Personal Information | |
| First/Last Name: | |
| Home Street Address: | |
| City: | |
| State/Province: | |
| Zip/Postal Code: | |
| Country: | |
| School/Grade/Subject: | |
| Phone: | |
| E-mail: | |
| (Please note that this is a printable form only) | |