One registration per form

Pre-register by March 12 Fee $75
Late Registration Fee $100

Hotel reservations should be made directly through the hotels by Februrary 28.

Registration Information

NAME:            
TITLE:           
ORGANIZATION:    
ADDRESS:         
CITY:            
STATE:           
COUNTRY:         
ZIP/POSTAL CODE: 
PHONE:           
FAX:             
E-MAIL:          
URL:             

Special Needs

Please check here if you have any type of special need, such as a disability or dietary requirement. We will contact you to discuss arrangements.

Transportation

If you plan to drive to the conference, please check here so that we can provide you with a parking permit and map.

If you plan to use the free shuttle service, please check your transportation needs.

from the Nashville airport to Murfreesboro on Sunday, March 31
from the Murfreesboro to Nashville airport on Tuesday, April 2
from designated hotels to banquet Sunday night, March 31
roundtrip between hotel and conference on Monday, April 1
roundtrip between hotel and conference on Tuesday, April 2

Meals and Special Events

Check below all meals and events that you plan to attend.

reception Sunday night, March 31
lunch Monday, April 1
banquet Monday night, April 1
lunch Tuesday, April 2

Payment

check or money order (made payable to Middle Tennessee State University)
Visa MasterCard
Amount:

Cardholder name:

Card number:

Expiration date:

Signature (required):

Form Submission

This form may be mailed or faxed.

Mail
Office of Information Technology
Attn: ITCONF
Cope 003
Middle Tennessee State University
Murfreesboro, TN 37132

Fax
(credit card registration only):
(615)898-5720

Cancellation/Refund Policy

All cancellations must be submitted in writing to the address on this form. Cancellations postmarked by February 29 will receive a full refund. A refund of $50 will be granted for cancellations portmarked between March 1 and March 12. No re funds after March 12.

[Mid-South Instructional Technology Conference]