Process Education Conference 2011

Please note that the conference itself will take place in Corey Union!

(Cortland faculty and staff should use the payment options
below in order to receive their host school discount!)

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

Registration Fees (includes annual Academy membership fee & most meals from Monday supper to Thursday lunch.)

Conference Registration (does not include lodging)		$300
Conference Registration (SUNY faculty)
Conference Registration (Cortland faculty & staff ONLY)		$50
EMERITUS Conference Registration		$50
Academy Membership Only		$50
(pay this only if you are not attending the conference)

Total Fees Owed:	$

I am paying my fees by:

Online Payment

Submit your registration and you will have the opportunity to complete your payment online, if you wish to use a credit or debit card (we use PayPal as our payment processor).

Other arrangements

SUNY Institutions ONLY (Please note that Cortland faculty & staff should select "Online Payment" above!)

I will mail a check

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

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