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2009 Conference

 

 

 

  Registrant Details    ( required fields)

 Name

  

Title/Department

School/Affiliation

Mailing Address 1

  

Mailing Address 2

City

State          Zip       Country 

 

  

Phone (home)

 

Phone (cell/mobile)     

Email
     
  Photo Release

We will have a photographer in attendance at the conference. Candid photos will be taken to be used for purposes such as Academy membership brochures, the Academy website, etc. If you object to your image being used for these purposes, please indicate at right.

You may use
my image

   

 Travel Information

I will be arriving by

Air      Car

Airline/Flight #

Airline   Flight #

Arrival

 Date     Time  

Departure

 Date     Time  

I need driving directions          YES       NO 

I will be staying for the Academy Meeting        YES       NO 

I am willing to share a room at the conference hotel:        YES       NO 

   

 Registration Fees

Conference Registration $300

(includes yearly Academy membership fee)
   
Conference Registration (for St. Louis area residents only)

I live in the St Louis area and am eligible for a reduced registration fee. Please contact Barbara Gist at 314-367-8700 or bgist@stlcop.edu for special rates. You must pay by check with this option.

 
Academy Membership Only $50

(pay this if you are unable to attend the conference but want full membership in the Academy)
 
 Dinner Cruise Guests  

The participant's dinner cruise expense is covered in the conference registration fee. Please indicate if you will be bringing other guests on the cruise:

Adults ($40 regular meal)  AdAdults ($50 upgraded meal)  Children 3-12 ($20 ea)
Children under age 3 are free. Please bring a check to cover all guests to conference registration.
   

 I am paying my fees by: 

Online Payment Submit your registration and you will have the option to pay your fees online from your registration confirmation page.
I will mail a check

Checks should be payable to Academy of Process Educators and mailed to:

Dr.  Peter Smith
1036 North Niles Ave
South Bend, IN 46617

 

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