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Online Registration

INFORMATION
Name Social Security Number

Address 
City
State
Zip Code

Country 
Organization/Affiliation
Position 
Daytime Phone
Other Phone
Fax (optional)
Email


 

EVENT PRE-REGISTRATION

Please pre-register for the following activities which you plan to attend:
Sunday evening Dinner & Awards Speakers (no additional fee for paid conference participants - guest tickets available)
Monday afternoon Putt-Putt Tournament (no fee)
Monday evening Cracker Barrell Session & Poolside Beer & Wine Party (included - conference participants only)
Tuesday evening Riverside Dinner Party (no fee for conference participants - guest tickets available)
Wednesday Closing Lunch & Keynote (included - conference participants only)

 

FEES

Conference Registration Fee (please check one)

 
On or before April 22
April 23 - May 15
On-Site
$295
$360
$415
Guest Ticket for Sunday Opening Dinner & Award Speakers - $30
Guest Ticket for Tuesday Riverside Dinner Party & Dance - $38 
Children's (under 12) Tickets for Tuesday Riverside Dinner Party $19 - each

Total (Registration fee plus Extra Guest Tickets if applicable) - $

FORM OF PAYMENT
Purchase Order
If Purchase Order, please supply PO# 

Fax Purchase Order to: (678)839-0636, attn: Stacey Rowland. Must be received within 24 hours of registration.

Credit Card
(please contact Stacey Rowland or Christy Talley at (678)839-6248 to process card.)
I will mail a check (drawn on US funds) by May 5, 2006.
Please make payable to: 
University of West Georgia DLA Conference.

Mail to:

DLA2006 Conference

State University of West Georgia,
Distance & Distributed Education
Honors House
attn: Stacy Rowland

Carrollton, Georgia 30118.


IF YOU'D RATHER FAX THE FORM:

If you prefer, you may fill out the form, print it, and fax it to us at (678)839-0636, attention Stacey Rowland. If you choose to fax the form, do not hit the submit button. You should receive an email confirmation within 1 business day, and a confirmation by mail in 1-2 weeks.

CANCELLATION AND REFUND POLICY:
Checks, purchase orders, or credit card information received at the above address by April 22, 2006 qualify for the lowest rate. Refunds minus $25 cancellation fee will be issued after the conference for cancellations received in writing by April 20, 2006. No refunds will be issued after that date.