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Old Saybrook 2 Conference Registration

To register for the Old Saybrook 2 Conference, print and complete the following form and mail to:
OS2, Department of Continuing Education/Public Services
State University of West Georgia
Carrollton, GA 30118-6000

Personal Information

Name (First, M.I., Last):
 
Social Security Number (for database identification purposes):
 
First name preferred on name badge:
 
Gender:
 
Institution/Organization:
 
Address:
 
 
City:
 
State:
 
Zip Code:
 
Country:
 
Phone:
 
Fax:
 
Email Address:
 
Special Dietary Needs:
 
Do you need any special accomodations? (specify):
 

Registration Fee

Please check the appropriate registration category below. Payment is due with registration. Deadline for registration is March 24, 2000. However, housing requests can only be satisfied if registration and payment are received by March 24.

Registration with campus lodging:
____ $395 Includes single/double room in residence hall May 11-13, meals from Thursday dinner through Sunday lunch and breaks. Postmarked by March 24, 2000.
____ $420 Includes same as above. Postmarked after March 24, 2000.

Students: (proof of current student status required)
____$190 Students w/lodging. Includes same as above.
____$125 Students w/out lodging.

Registration without campus lodging:
____$325 Includes everything except housing. Postmarked by March 24,2000.
____$350 Includes same as above. Postmarked after March 24, 2000.
____I understand that I need to make reservations with Holiday Inn Express directly. (Motel reservation cut-off date: April 11, 2000.)

Options:
____$23 per extra night for on campus housing. Date(s)_____________________
____$55 airport transportation. Arrival time/date___________ Departure time/date_________

_____TOTAL

Roommate request (Only mutual requests can be honored.)
 
Choose one (for on campus lodging):

NOTE TO PARTICIPANTS: The conference cancellation policy requests notice in writing before April 7, 2000 in order to receive a refund. After April 7, 2000 no refunds!

Payment Method

Payment must accompany form!

Method of Payment (U.S. Funds only)
 
Credit Card Number:
 
Credit Card Expiration:
 
Name as it appears on the Card:
 
Signature:
 

If you have any further questions about conference registration, please email us your questions or concerns.