Registration Form

		*Energizing our* *Front-Line Network* *Registration Form* *REGISTRATION IS CLOSED! Come back after April 1.*

The conference fee is $85.

Registration Closes April 30, 2008.
Payment method is by purchase order or check only, NO credit cards. Payments or purchase orders must be received by May 11, 2008.

Options of Payment (check one):
Purchase order will be sent from campus. (Your campus will be billed after the conference.) Put the following vendor number on your Purchase order: 20036365800 (Office of the Chancellor)

Those paying by purchase order will be billed. Please do not send your purchase order until you have been billed.

Campus check or my check will be sent or hand-delivered. (If you are an individual paying and are expecting campus reimbursement for your registration fee, be sure and check with your supervisor for authorization prior to the deadline date.)

Make your check payable to:
Barb Miller
Minnesota State Colleges and Universities
30 7th Street East
Suite 350
St. Paul, MN 55101

Cancellations
All cancellations after 8 a.m. on May 16 will be subject to a $35 minimum charge. Any refund for cancellations after applying the $35 minimum charge will be determined on a case-by-case basis. Cancellation request should be sent to this link below.

Name: (Last, first)
Home Campus:
Address:
Work Phone:
Job classification/dept. you work for on your campus (ex.:Sec/Dean's ofc):

I will be arriving on:
I will be there for the first Keynote address at 1 p.m.:
I will be staying for both days:
I will be staying for dinner on Tuesday evening:

The meals will consist of:

Tuesday
Lunch:	Deli Box Lunch
Dinner (Please select one):

Wednesday:
Continental Breakfast:
Lunch:	Deli Box Lunch

Do you want a vegetarian box lunch: (Please do not take one if you don't select 'yes'!)

I have special dietary needs (pls. be specific):

I will attend one of the following meetings during each session (click the down arrow):
Session I:	(Tues: 2:20-3:20)
Session II:	(Tues: 3:40-4:40)
Session III:	(Wed: 9:00-10:00)
Session IV:	(Wed: 10:20-11:20)

I will be there for the final keynote:

I need special accommodations (i.e., Sign Lang. interpreter, wheelchair access):

My e-mail address is:

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