MWACSM ANNUAL MEETING REGISTRATION FORM October 28-29, 2011 University Place, IUPUI, Indianapolis, Indiana

Name/Degree (ex: Jane Doe, Ph.D.):
First Name for Name Tag (ex: Jane):
Affiliation (ex: Bowling Green State University):
Address:
City / State / Zip:
Phone #:
E-Mail:

Please review these choices, then select the option form the 'Choices' drop down selector below.

Choices

					Pre-Registration (by 10/7/2011)		Registration (after 10/7/2011)


SINGLE DAY CONFERENCE REGISTRATION
MWACSM Members
Professional					$50				$75
Student						$25				$50				

Non-MWACSM Members
Professional					$85				$110
Post-docs & Students				$50				$75

Click the Next button below. You will be taken to a PayPal screen where you will be prompted for payment information. Upon completion, information will be sent to the MWACSM office. A printable receipt will appear once your payment is processed.

Questions? Please contact mwacsm@bgsu.edu.