2008 Workshops for Department and Division Chairs
Registration Form

*Workshop your registrants will attend:
Portland, OR (April 4 - 5)
Atlanta, GA (May 20 - 22)
  [Chicago Registration Full]
  [Albany Registration Full]

Note: If your institution is sending registrants to more than one workshop, please specify in the special needs / comments box at the bottom of this form. You need only submit one registration form for your entire institutional team.

College/University Name and Address

*Institution:

*Address:

*City, State, Zip:

*Phone #:

*Fax #:

Note: If you have an administrative title, such as department chair or associate dean, please provide this title in the Title/Department box below, rather than your faculty rank. In addition, please provide your department/discipline in the same box. If you only have a faculty rank, then list this title along with your department/discipline.

Main Registrant

*Name:

*Title/Department:

Direct Phone #:

*E-mail:

Additional Registrants

1.

Name:

Title/Department:

Direct Phone #:

E-mail:

Fax:

2.

Name:

Title/Department:

Direct Phone #:

E-mail:

Fax:

3.

Name:

Title/Department:

Direct Phone #:

E-mail:

Fax:

4.

Name:

Title/Department:

Direct Phone #:

E-mail:

Fax:

5.

Name:

Title/Department:

Direct Phone #:

E-mail:

Fax:

*Member
Rates:

First registrant @ $380

additional registrants @ $320 each

*Nonmember
Rates:

First registrant @ $480

additional registrants @ $420 each

$

Special Needs / Comments: