2010 NCLCA Conference Registration



Last Name:	*
Are you a current NCLCA member?	*	Yes No
I currently hold NCLCA Learning Center Leadership Certification and would like it so noted on my conference name badge:		Yes No
First Name:	*
Middle Initial

Institution:
Institution Size
Institution Type
City of Institution:	*
State/Providence of Institution:	*

Work Address:	*
Address Line 2:
City:	*
State/Province:	*
Country:	*
Postal Code/Zip:	*
Daytime Phone Number	*
Cell Phone (In case we need to reach you while at the conference):
E-Mail Address	*
Fax Number

Did you submit a proposal?	*	Yes No
Are you a first-time NCLCA Conference attendee?	*	Yes No
Session moderators introduce concurrent sessions and the presenter, provide the attendees with a session evaluation, collect evaluations at the close of the session, and monitor the presenter's time as requested.
Would you be willing to serve as a session moderator?		Yes No
Will you be attending Thursday's Awards Banquet (included in price of conference)?	*	Yes No
Will you be attending Friday's CCG luncheon (included in price of conference)?	*	Yes No
Are you interested in serving as a facilitator for Friday's CCG Luncehon? (A facilitator helps to spur discussion at the table.)		Yes No
Do you prefer vegetarian selections?	*	Yes No
Do you prefer kosher/halal selections?		Yes No

Conference Registration Type:	*
If you only registered for one day, please select the day you will attend the conference:
If you selected membership as part of your registration, please answer the questions below:
Membership Type:
New or Renewal Membership:
Have you earned LCLC?
Are you interested in serving on a committee?


You will find titles and schedule of Pre & Post-Conference Institutes below:
Wednesday, September 29th 9 AM- 12 Noon: Pre-Conference Institutes A & B
Pre-Conference Institute A: Help! I'm a New Learning Center Director- Alan Craig		Yes No
Pre-Conference Institute B: Evaluating Your Tutoring Program Using NADE Guides to Self-Evaluation, 2nd Edition - Linda Thompson & Karen Patty-Graham		Yes No
Wednesday, September 29th 2 PM- 5 PM: Pre-Conference Institutes C- E
Pre-Conference Institute C: Personalized Academic Assistance: The Art of Building an Academic Coaching Program - Elizabeth McWilliams		Yes No
Pre-Conference Institute D: CLADEA Leadersip Institute - Jack Truschel & Russ Hodges		Yes No
Pre-Conference Institute E: Workshop by Frank Christ		Yes No
Saturday, October 2nd 9 AM- 12 Noon: Post-Conference Institutes F & G
Post-Conference Institute F: Racing into the Future of Learner Support and Center Management - Lisa D'Adamo-Weinstein, Craig Lamb, and Tacy Holliday		Yes No
Post-Conference Institute G: Setting Your GPS for Success: Developing a Strategic Plan for Your Learning Center - Wendy Wilson		Yes No

All conference institutes are an additional $50. However, you will receive a discount for each additional conference institute you register for. NCLCA Package deals are outlined below:
Package A- One Institute- $50
Package B- Two Institutes- $90
Package C- Three Institutes- $125
Select Package		A- One Institute $50 B- Two Institutes $90 C-Three Institutes $125

Please compile all selections and enter a total price for your registration:	*
Method of Payment:	*
To receive early registration discount, payment must be received by September 10, 2010.
Conference Refund Policy: NCLCA will consider refund requests until September 21, 2010 (7 days prior to the start of the conference). Please request your refund in writing from the NCLCA Vice President Elaine Richardson (ERCHRDS@clemson.edu). There will be a $25 processing charge. From 7 days to the start of the conference, NCLCA will consider refund requests only in situations such as serious personal illness or a death in the family. An additional $25 processing charge applies for unrecoverable food costs.
Before you submit, look over your choices carefully to check for any errors. Print this registration form for your records. You will need your print out in order to pay using PayPal, or, alternatively, as you write a check to mail.
Please provide any notes or special accommodations in the space below. All requests/notifications will be passed onto the conference organizer.		None