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MICS 2001 Registration Form
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FAX 319-273-7338 |
K. Andersen |
Phone 319-273-6988 |
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Name |
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Address |
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City State Zip |
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Phone Fax |
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School/Organization |
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š Check here if you have any special needs (including dietary). We will call todiscuss how to meet your needs. |
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š Check here if you do not want your name, address, phone, and e-mail included on a participant list. |
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Register me for: (Please circle) |
By 3/22 |
After 3/22 |
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Faculty/staff |
Full conference registration |
$145 |
$195 |
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Friday only registration |
95 |
115 |
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Saturday only registration |
95 |
115 |
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Student |
Full conference registration |
75 |
95 |
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Friday only registration |
40 |
50 |
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Saturday only registration |
40 |
50 |
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WebCT workshop |
25 |
25 |
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Making Class Time Count workshop |
25 |
25 |
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Per |
Per |
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Additional Friday banquet tickets |
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20 |
20 |
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Additional Friday lunch tickets |
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10 |
10 |
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Additional Saturday lunch tickets |
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10 |
10 |
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Payment information: |
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q VISA q MASTERCARD q DISCOVER |
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Account # Exp Date |
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Signature |
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Educational Event Management requests this information for the sole purpose of registering you for this program. We do not routinely release any of this information to anyone outside our institution without express permission. We do ask that you fill out all the registration items that apply to you. We are unable to process forms that do not include your name and address.
The University of Northern Iowa is an equal opportunity educator and employer with a comprehensive plan for affirmative action
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