2010 MassACDA Summer Conference
Fees & Registration
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Name
Address
City State Zip
Home phone Work phone
Email address
Requested roommate
(Optional; same gender roommate only)
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1. Are you seeking professional development points (PDP's)? |
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____Yes |
_____No |
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2. One graduate credit is being offered for this workshop for $250 (bachelor’s degree required). Are you seeking graduate credit? (If yes, you will be contacted by Gordon College to register for graduate credit; a separate registration form is required.) |
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____Yes |
_____No |
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3. Will you be attending the Sunday Evening BBQ dinner? (no additional cost) |
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____Yes |
_____No |
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Conference Fees (Checks made payable to MA ACDA) |
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Regular Registration _____ Registration postmarked by June 1 ($230) _____ Registration postmarked by June 15 ($250) _____ Registration postmarked after June 15 ($270) |
Special Registration _____ Student rate ($60) (valid full-time student ID required) _____ Per diem = No. of days x $80 (Any portion of a day counts as a full day) Circle days: S M T W _____ Retiree ($170) |
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Meal Plans (optional) _____ Meal Plan A: July 12–14, lunch only ($27) _____ Meal Plan B: July 12–14, all meals ($78) --or-- Create your own (circle days requested) _____ Breakfast ( M T W ) x $7 each _____ Lunch ( M T W ) x $9 each _____ Dinner ( M T W ) x $10 each |
Housing Plans (optional) _____ Plan A1: July 11–13, on-campus single occupancy ($138) _____ Plan A2: July 11–13, on-campus double occupancy ($108) --or-- Create your own (indicate NIGHTS room requested) _____ On-campus single occupancy ( S M T ) x $46/night _____ On-campus double occupancy ( S M T ) x $36/night |
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Total = $ |
Payment Method (circle one): Cash Check (NOTE: Credit card payments not accepted.) |
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Make checks payable to MA ACDA and mail with this form to: |
OFFICE USE ONLY |
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Dr. Sandra Doneski MA ACDA Summer Conference Gordon College 255 Grapevine Rd. Wenham, MA 01984 |
Date ID # Total due Check # Worksheet |
Requests for refunds must be made by July 1, 2010.
For more information contact Faith M. Lueth flueth@comcast.net
Last revised April 17, 2010
