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
   

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 Saturday Academy Meeting          YES       NO 

   

Registration Fees

  Before May 15, 2008 After May 15, 2008
Conference Registration $300 $325

(includes yearly Academy membership fee)
 
  Before May 15, 2008 After May 15, 2008
Academy Membership Only $50 $50

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

 
  Before May 15, 2008 After May 15, 2008
Lt. General Honoré Presentation Luncheon $25 $25

(select this option only if you are not registering to attend the rest of the conference)
 
Note:

Hinds Community College personnel should register with Vickie Kelly. Please call her at (fill in phone number) or email her at VAKelly@hindscc.edu. For those only able to attend for one day, contact Vickie for the adjusted rates.
   

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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