Registration

NOTE: Conference registration does NOT include accommodations. Please be sure to make your own lodging reservations directly. Remember to download the Room Reservation Form from the Conference Page. Room reservations should be made as early as possible and before February 26, 2011.

Make conference registration/membership dues checks payable to SRFIDC. Please be aware that dues and pre-paid conference registration are not refundable.  After filling out the registration form please mail your payment with your name and institution name to:

Irene Kokkala, Center of Teaching & Learning Excellence
375 Library Technology Center
North Georgia College & State University
82 College Circle, Dahlonega, GA 30597

Tax Identification Number: TIN #51-0318435

Name of Person Completing Form: *

email address: *

Institutional Representatives

Please complete this information for each institutional representative who will be attending the SRFIDC Annual Sharing Conference.

Name: *

Email: *

More Representatives:

List any other representative's names and emails here.

Institutional Information

Institution Name: *

Center/Program Name: *

Address: *

Address:

City: *

State: *

Zip: *

Phone:

Fax:

Website:

Fees

Number of Participants: *

Individual = $175.00

2 representatives = $250.00

3 representatives = $375.00

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 2011 SRFIDC Annual Sharing Conference (March 25-29, 2011). Please make all checks payable to SRFIDC. Tax Identification Number (TIN): #51-0318435

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