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2017 Narrowing the Gulf Conference Registration Form

Narrowing the Gulf for Underrepresented Students in Postsecondary Education
18h Annual Conference

Co-sponsored by:
St. Petersburg College Center for Excellence in Teaching and Learning (CETL), Florida Association on Higher Education and Disability (FL-AHEAD) and St. Petersburg College’s Retention Services Department

April 6-7, 2017
St. Petersburg College EpiCenter
13805 58th Street North
Clearwater, FL 33760

Please fill out the following form to register for the 18th Annual Narrowing the Gulf Conference at St. Petersburg College.

* 1.

First Name

* 2.

Last Name

* 3.

Are you a member of the Association on Higher Education and Disability?

* 4.

Name as you would like it to appear on badge

* 5.

Title

* 6.

Organization

* 7.

Address

* 8.

City

* 9.

State

* 10.

Zip Code

* 11.

Phone

* 12.

E-mail address

* 13.

Registration fee

14.

Payment method (Credit cards are not accepted for this conference.) 

St. Petersburg College Employer Identification #59-1211489

15.

Purchase Order Details

(St. Petersburg College Employer Identification# 59-1211489)

16.

Check Number Details

(St. Petersburg College Employer Identification# 59-1211489)

* 17.

Do you need special accommodations to participate in this conference? If yes, a representative from the conference will contact you to arrange accommodations.
 

If you have comments about this form or questions regarding how to complete this form, please contact Aimee Stubbs at Stubbs.Aimee@spcollege.edu or call 727-341-3398 Fax: 727-499-9023.

The Board of Trustees of St. Petersburg College affirms its equal opportunity policy in accordance with the provisions of the Florida Educational Equity Act and all other relevant state and federal laws, rules and regulations. The college will not discriminate on the basis of race, color, ethnicity, religion, sex, age, national origin, marital status, pregnancy, sexual orientation, gender identity, genetic information, or against any qualified individual with disabilities in its employment practices or in the admission and treatment of students. Recognizing that sexual harassment constitutes discrimination on the basis of sex and violates this Rule, the college will not tolerate such conduct. Should you experience such behavior, please contact the Equal Access Equal Opportunity Director/Title IX Coordinator at 727-341-3261; by mail at P.O. Box 13489, St. Petersburg, FL 33733-3489; or by email at eaeo_director@spcollege.edu or spctitleix@spcollege.edu.