(Fields marked with * are necessary fields)
*Name:	* (Please print name as you would like it to appear on your nametag.)
*Mailing Address:	*
*City:	*	State	Zip
Daytime Phone Number:	( ) - -
Email Address	*
Spouse Name: (if attending)
*Location I will attend:	select one Abbeville Anderson Barnwell Beaufort Bennettsville Bishopville Camden Charleston Chesterfield Chester/Lancaster Clemson Columbia Conway Darlington Edgefield Georgetown Greenville Manning Marion Newberry Sumter Union Walterboro York *
*Registration:	Registration Fee ---- $140
	Spouse Fee --- $60
	Total due $ to Clemson University*
*Credit Card:	select one Visa Mastercard *
*Card Number:	- - - *
*Expiration Date:	1 2 3 4 5 6 7 8 9 10 11 12 - 2004 2005 2005 2006 2007 2008 2009 *
*Name of Cardholder:	*

Note: Please be patient and press the Submit button only once. If you press the submit button twice, your credit card will be charged twice