Humanities Institute Registration
First Name
(As it should appear on nametag.)
Last Name
Gender
Male
Female
Home Address
City, State/Prov., Zip
School Name
School Address
City, State/Prov., Zip
Home Phone
School Phone
Fax
Email Address
What subject do you teach?
Housing Request
Dorm Housing
Hotel Information
All accommodations are single-room unless otherwise indicated by both participants writing in the name of their desired roommate. Roommates must be of the same gender.
Roommate's name
(if applicable)
How did you hear about EHI
(mailing, website, other)?
Would you like to receive future correspondence via email?
Yes
No
Payment Enclosed
US $850 Check payable to Phillips Exeter Academy
Check here if funded by The Stranahan Foundation
Type in fields, print and mail completed form with payment to:
Exeter Humanities Institute, Phillips Exeter Academy, 20 Main Street, Exeter, NH 03833-2460