Conference Programs are distributed to all the registered participants at the conference. To place an ad in the 2006 Conference Program, please complete this application form. Mail the payment and artwork (electronic or camera-ready) to the Center on Disabilities no later than January 6, 2006.
*Note: all advertisements are printed in black & white.

Company Name:________________________________________________________
Contact name: _________________________________________________________
Street Address:_________________________________________________________
City:__________________________________State/Province/Region:______________
Zip/Postal Code: _____________Country:____________________________________
Day Phone: ____________________________Fax:____________________________
Email: ________________________________________________________________

ADVERTISING in the Conference Program:
Artwork due January 6, 2006.

__ Full Page 7 1/2"(w) x 10"(h): $575
__ Half Page 7 1/2"(w)x 4 1/2"(h): $365
__ Quarter Page 3 1/2"(w) x 4 1/2"(h): $195

METHOD OF PAYMENT

__ Check enclosed for: $________Make payable to CSUN (U.S. Dollars)

__ Charge to: __ VISA __ MASTERCARD __ AMERICAN EXPRESS

Name of Credit Card Holder: _____________________________________________
Card #:_______________________________________Exp. Date: ___________________

Please send completed application form and payment to:
Speaker/Publication Coordinator
Center on Disabilities, California State University, Northridge
18111 Nordhoff Street
Northridge, CA 91330-8340

Phone: 818. 677.2578 V/TTY/Message FAX: 818.677.4929
Email: conference@csun.edu Website: www.csun.edu/cod