Registration Form

20th Annual Minority Health Conference
The Many Faces of Violence: Strategies for Prevention for the New Millenium

February 19-20, 1998

To register, please provide the following information and then click the REGISTER NOW button.

We ask that you voluntarily provide your Social Security Number with the understanding that it will be used only as an identification number for internal record keeping and data processing operations at the University of North Carolina at Chapel Hill.

Social Security Number
Address-business address if applicable(line 1)
Address (line 2, if needed)
State ZIP +4 (if known) Country (if not US)
NC State Courier Code

E-mail address
Job Title/Position

Daytime Phone (area code+number)
Fax Phone (area code+number)
Evening Phone (area code+number)

Are you a student, faculty member, or staff member at UNC-CH?
Yes No

Are you a graduate of the UNC-CH School of Public Health?
Yes No     If so, please indicate year of graduation (19xx format) 

I would like to receive e-mail announcements of upcoming public health programs.

I have special needs for overnight accommodations, learning aids, and/or facility accessibility information.

Registrations are accepted on a first-come/first-served basis and space in this program is limited. To ensure your place, please register as soon as possible. If the program you register for is full, your name will be put on a waiting list and you will be notified.

Registration Fee:
$50 (except UNC Faculty/Staff/Students, and Senior Citizens -- no fee)
$65 for on-site registration

To submit your registration, click the REGISTER NOW button.


Admission to School of Public Health programs is without regard to race, sex, national origin, color, religion, handicap, age or veteran's status.
Program Information CE Calendar OCE
CDLHC School of Public Health UNC-Chapel Hill 

If you have any questions about this videoconference or registration, please call 919-966-4032 or send email to

If you have any questions or comments about this page, please contact Becky Hart at Last updated December 11, 1997.