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 10/7/11)		Registration (after 10/7/11)								
FULL 2-DAY CONFERENCE REGISTRATION		
Circle All Appropriate Fees and Meals
MWACSM Members
Professional					$100			        $125
Students					$35				$60	

Non-MWACSM Members
Professional					$135				$160
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.