Register for Conference

	CCNCCE 2010 Annual National Conference *Formulas 4 Success in Service Learning and Civic Engagement* 2010 CCNCCE Conference Registration 2010 CCNCCE Conference Registration There will be a $50 registration cancellation fee prior to April 20. Registration fees are not refundable after April 20. Note: Registrations are transferable. * Required ATTENTION PRESENTERS!!! IF YOU ARE A PRESENTER, DO NOT COMPLETE THIS FORM. Your "Submit Proposal" form contains all your registration information and is used to register you for the conference. Please see "Submit Proposal" form. First Name * Last Name * Job Title Department Institution Did your college receive the 2009 President's Community Service Honor Roll award? * If you don't know, please go to this url to view the list of recipients: http://www.learnandserve.gov/about/programs/higher_ed_honorroll.asp Yes No Street Address * Street Address-2 City * State * Please use the 2-letter abbreviation. Zip Code * Phone Number Fax Number Email Address * Meal Preference * Please choose one only. If there are certain types of meat you don't want to be served, you should select the vegetarian/vegan option. Regular Vegetarian/vegan meals. Food Allergies Please list any food allergies we should be aware of. Pre-conference Fee * There is a separate fee for attending the pre-conference. This is not included in the regular conference fee. (Please see the fees section of the conference information page.) The pre-conference fee covers both morning and afternoon pre-conference. The pre-conference fee is the same whether you attend a morning pre-conference, afternoon pre-conference, or both morning and afternoon pre-conference. Please choose the pre-conference fee which applies to you. $0 - I will not be attending the pre-conference. Early Bird--on or before April 20 ($150) Regular ($175) Morning Pre-conference Selection * Please choose one. Afternoon Pre-conference Selection * Please choose one. Early Bird Fees (on or before April 20 - Skip if after April 20) If it is after April 20, please skip this question and choose from the regular conference fees. If it is on or before April 20, please indicate which registration type applies to you. College/University ($425) Community Agency/Partner ($375) Student ($300) Thursday Only ($225) Friday Only ($200) Regular Fees (after April 20 - Skip if on or before April 20) If it is on or before April 20 and you have made your Early Bird fee selection, you may skip this question. Otherwise, please indicate which registration type applies to you. College/University ($445) Community Agency/Partner ($400) Student ($325) Thursday Only ($250) Friday Only ($200) Check or PO Number (optional) Please type in any relevant information we should have regarding your payment here. Please note that we do not accept credit cards. You may register without filling in this field. We will invoice you once we receive your registration. Will you be staying for lunch on Friday, May 28? * Yes No Photography and Participant Release: Submission of your Conference Registration and/or Proposal to Present authorizes CCNCCE to publish in any format and use for any purposes your name, affiliation, and any photographs, video footage, and audio recording taken of you at the 2010 CCNCCE Annual National Conference. Request for ADA Accomodations To request ADA accommodation(s), please do the following: Submit an e-mail request to gloria.schoonover@mcmail.maricopa.edu on or before April 15, 2010. The e-mail subject line needs to read "ADA Accommodation Request". Indicate the ADA accommodation(s) requested below and submit your registration on or before April 15, 2010. ADA Accomodation Requested: Powered by Google Docs Report Abuse - Terms of Service - Additional Terms