Registration Form :: 10th Annual Instructional Technology Conference

Tenth Annual
Instructional Technology Conference
Middle Tennessee State University
Building Communities of Learners
April 3-5, 2005

Registration Form

If paying by credit card, use the secure credit card registration process or print the registration form (PDF) for mailing
One registration per form.
Early Bird discount registration and payment due by March 18: $125
Pre-conference workshop registration and payment due by March 18: $50 (no pre-conference workshop registrations will be accepted after March 18, 2005)
Fee after March 18, 2005: $150
Hotel reservations should be made directly through the hotel by March 7 .

Registration Information

First Name:
Last Name:
Title:
Organization:
Address:

City:
State:
Country:
ZIP/Postal code:
E-mail:
Phone:
Fax:

Transportation

Check here if you will need transportation between Double Tree (formerly Garden Plaza) and MTSU. Shuttle service is available between these locations only.

Pre-conference Workshop

(check one only)

None
Macromedia Dreamweaver for Beginners (Formosa)

Meals and Special Events

Check below all meals and events that you plan to attend. To keep conference cost to a minimum, please check ONLY the meals and events that you plan to attend.

Reception Sunday evening at the Double Tree (formerly Garden Plaza) Hotel
Lunch Monday on the MTSU campus
Banquet Monday evening at the Double Tree (formerly Garden Plaza) Hotel
Lunch Tuesday on the MTSU campus
None

Early Bird registration and payment due by March 18: $125
Pre-conference workshop registration and payment due by March 18: $50 (no pre-conference workshop registrations will be accepted after March 18, 2004)
Fee after March 18, 2005 : $150

Purchase Order No.
Check (made payable to Middle Tennessee State University)

For credit card payment, use the secure credit card registration site or print a credit card form (PDF) and mail to the address listed below.

Form Submission

Electronic

This form may be electronically submitted if paying by PO or check. Please complete registration process by mailing PO or check to the MAIL address below by March 18 for Early Bird registration.

We will begin mailing confirmations and registration packets in mid-February, 2005.

Mail

Mail PO, check, or credit card form (PDF) to the address below:

Information Technology Division
Attn: ITCONF
Cope 003
Middle Tennessee State University
Murfreesboro, TN 37132

Fax

Credit card forms (PDF) can be faxed to the following number:

(615) 898-5720

Cancellation/Refund Policy

All cancellations must be submitted in writing to the address on this form. Cancellations postmarked by March 18, 2005, will receive a full refund.

No refunds after March 18, 2005.

Sign-Up for Regular Conference Workshops

Sign-up for regular workshops will be on a first-come, first-served basis at the conference registration desk:

Sunday, April 3, 6-8 p.m. at Double Tree (formerly Garden Plaza) Hotel
Monday, April 4, & Tuesday, April 5, beginning at 7:00 a.m. at MTSU's Keathley University Center

[Mid-South Instructional Technology Conference]

For internal use only---> Date rec'd________ Entered________Check No._______Amt Rec'd________