Southern Regional Faculty and Instructional Development Consortium 2008-09 Membership Form & Sharing Conference Registration Annual Institutional Dues: July 2007 - June 30, 2008 Please select the number of people from your institution for which you are paying dues. These dues entitle your institution to participate in the 2008 SRFIDC Annual Sharing Conference (March 16-18, 2008). Please make all checks payable to SRFIDC. Tax Identification Number (TIN): #51-0318435 2 representatives = $250.00 3 representatives = $425.00 4 representatives = $500.00 More than 4 representatives (Note: Additional representatives = $125.00 each) Annual Individual Dues: July 2007 - June 30, 2008 ($175) Institutional Representatives: Please complete this information for each institutional representative who will be attending the 2008 SRFIDC Annual Sharing Conference. Last Name First Name Position Email Institutional Information Institution Name: Center/Program Name: Address: Address: City: State: Zip: Phone: Fax Number: Website: Additional Information: Opening Barbecue Lunch (Sunday, March 16, 2008: 12:00 pm - 1:30 pm) - NO Charge This event is included in the registration for the conference. Location: Tigertail Lake Conference Center in Dania Beach Meet in the hotel lobby at 11:00 am. Please let us know the number of representatives from your institution will plan to attend. Number Attending Luncheon Night on the Town (Monday, March 17, 2008) - $35 per person This event is NOT included in the registration fee for the conference; participants will pay for their own meal. This is a great opportunity to have additional conversations in a relaxed and fun environment and to explore local cuisine. Number Attending Night on the Town Membership Fees Total: $ Night on the Town Total: $ Late Registration Fees ($75): $ TOTAL ENCLOSED: $ Name of Person Completing Registration Form: Email Address: NOTE: Conference registration does NOT include accommodations. Please be sure to make your own lodging reservations directly with the Hampton Inn. Remember to request the group rate for SRFIDC. Hotel reservations must be made by February 15, 2008. Conference rates cannot be guaranteed after that date. Make conference registration/membership dues checks payable to SRFIDC. Print the registration confirmation and mail it with your payment to: Irene Kokkala, Center of Teaching & Learning Excellence 407 Health & Natural Sciences Building North Georgia College & State University 159 Sunset Drive, Dahlonega, GA 30597 Tax Identification Number: TIN #51-0318435 (Click the "Submit" button to display a printable confirmation to mail with your registration fees.) If you have questions regarding payment, please call Irene at (706)864-1862 or email her at ikokkala@ngcsu.edu. Registration Deadline: February 28, 2008 An additional $75/person will be charged for late or onsite registration.
Southern Regional Faculty and Instructional Development Consortium 2008-09 Membership Form & Sharing Conference Registration
Annual Institutional Dues: July 2007 - June 30, 2008
Please select the number of people from your institution for which you are paying dues. These dues entitle your institution to participate in the 2008 SRFIDC Annual Sharing Conference (March 16-18, 2008). Please make all checks payable to SRFIDC. Tax Identification Number (TIN): #51-0318435 2 representatives = $250.00 3 representatives = $425.00 4 representatives = $500.00 More than 4 representatives (Note: Additional representatives = $125.00 each)
Please select the number of people from your institution for which you are paying dues. These dues entitle your institution to participate in the 2008 SRFIDC Annual Sharing Conference (March 16-18, 2008). Please make all checks payable to SRFIDC. Tax Identification Number (TIN): #51-0318435
2 representatives = $250.00 3 representatives = $425.00 4 representatives = $500.00 More than 4 representatives (Note: Additional representatives = $125.00 each)
2 representatives = $250.00
3 representatives = $425.00
4 representatives = $500.00
More than 4 representatives (Note: Additional representatives = $125.00 each)
Annual Individual Dues: July 2007 - June 30, 2008 ($175)
Institutional Representatives: Please complete this information for each institutional representative who will be attending the 2008 SRFIDC Annual Sharing Conference.
Last Name
Position
Email
Institutional Information
Institution Name:
Center/Program Name:
Address:
City: State: Zip:
Phone:
Fax Number:
Website:
Additional Information:
Number Attending Luncheon
Number Attending Night on the Town
Membership Fees Total:
$
Night on the Town Total:
Late Registration Fees ($75):
TOTAL ENCLOSED:
Name of Person Completing Registration Form:
Email Address:
NOTE: Conference registration does NOT include accommodations. Please be sure to make your own lodging reservations directly with the Hampton Inn. Remember to request the group rate for SRFIDC. Hotel reservations must be made by February 15, 2008. Conference rates cannot be guaranteed after that date.
Make conference registration/membership dues checks payable to SRFIDC. Print the registration confirmation and mail it with your payment to:
Irene Kokkala, Center of Teaching & Learning Excellence 407 Health & Natural Sciences Building North Georgia College & State University 159 Sunset Drive, Dahlonega, GA 30597
Tax Identification Number: TIN #51-0318435
(Click the "Submit" button to display a printable confirmation to mail with your registration fees.)
If you have questions regarding payment, please call Irene at (706)864-1862 or email her at ikokkala@ngcsu.edu.
Registration Deadline: February 28, 2008 An additional $75/person will be charged for late or onsite registration.
