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I . Personal Data (Please use the lines below to indicate how your name and affiliation should appear on your badge.) <br />First Name Initial <br />Last Name <br />Affiliation <br />Mailing Address <br />City State <br />Daytime Phone <br />2. Preregistration <br />OAH Member @ $45 $ <br />Student /Income under $20,000 _ @ $25 $ <br />Nonmember @ $65 $ <br />Guest* @ $25 $ <br />Guest Name: <br />*Guest registration is for nonhistorians who would not otherwise <br />attend the meeting except to accompany the attendee. <br />ZIP Country <br />Email <br />4.Additional Information <br />❑ Check here if you have a disability and require <br />accommodations to fully participate. OAH will contact you. <br />❑ I have the following dietary restrictions: <br />❑ I do not wish to receive email notices from exhibitors. <br />Total Preregistration: $ <br />3. Meal Functions and Special Events <br />Thursday,)uly 6 <br />Thursday Reception @ no charge $ <br />Friday, July 7 <br />Luncheon @ $17 ea. $ <br />Reception at the Nebraska State <br />Historical Society @ no charge $ <br />Saturday, July 8 <br />Luncheon @ $17 ea. $ <br />Session, Tour, and Reception at Homestead National <br />Monument of America @ no charge $ <br />S. Preregistration Summary <br />Total Preregistration (section 2) $ <br />Total Additional Events (section 3) $ <br />Total Payment $ <br />6. Payment Information <br />❑ Check Enclosed (payable to "OAH" and drawn in <br />U.S. funds on U.S. bank) <br />❑ Credit Card: ❑ MasterCard ❑ VISA ❑ American Express <br />Total Additional Events: $ Card Number <br />Expiration Date (mm / yyyy) <br />Signature <br />Postmark Deadline: dune 22, 2006 <br />