Please complete the following form and mail or fax to the address below. Beverly Smith, Registrar Fourteenth Annual Conference P.O. Box 8781 Williamsburg, VA 23187-8781, USA FAX: (757) 221-1047 First Name Last Name Address Line 1 Line 2 Line 3 City State Zip code Country Email Telephone Affiliation Yes, you may include my e-mail address in the list of conference participants for the registration package. I have the following special needs that I want to bring to the attention of the conference organizers: I will attend the following (check all that apply): Friday, June 6, 2008 Revolutionary Boston Walking Tour, 10:00 A.M. – 12:00 P.M. Number of persons Boston’s Black Heritage Trail Walking Tour, 12:00 – 2:00 P.M. Number of persons Reception, Massachusetts Historical Society, 6:00 – 7:30 P.M. Number of persons: Saturday, June 7, 2008 Reception, Faneuil Hall, 6:00 – 7:30 P.M. Number of persons: As requested by the Omohundro Institute’s Council and Executive Board, I would like to make a voluntary, tax deductible donation toward the costs of the Fourteenth Annual Institute Conference. Donation Amount: $ Payment Information Account Number Expiration Date: January February March April May June July August September October November December Card Holder's Signature ________________ Card holder's name printed______________

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