CONFERENCE REGISTRATION FORM

Please print or type:
						
Name:______________________________________________
						
Affiliation:_______________________________________
						
Address:___________________________________________
						
City:____________________ State:_______ Zip:_______
						
E-mail address:____________________________________
						
							
						

		Advanced      Late        Amount
Member		  $ 75	      $ 100     _________
Non-Member	  $ 85	      $ 110     _________
*Student	  $ 15	      $ 15      _________
Extra Luncheon  _____ @ $ 15            _________
Extra Banquet   _____ @ $ 25            _________
Membership Dues (if due)$  5  	        _________
TOTAL AMOUNT		               $_________
*Does not include lunch or banquet.  Each student
  presenter is invited to attend the banquet free 
  of charge with a maximum limit of two free banquet
  tickets per presentation in those instances where
  there are more than two students per presentation.

PAYMENT MUST BE ENCLOSED.  If a Federal Tax No. is 
needed, use ACM Federal Tax No. 13-1921358.  Purchase 
orders or credit cards are not accepted.  Make checks 
payable to:  ACM Mid-Southeast Chapter.

Mail to:	Emery Gathers			
		University of Tennessee at Martin
		College of Business and Public Affairs
            	112 Business Administration Building
		Martin, TN 38238

Please call Mack Thweatt (615) 898-2390 if you require 
		special disability accommodations.