2009 NCLCA Conference Registration

Please complete the registration form below.

**Notice**
As of today- Friday, September 25th, our committe members are in transit to Golden, CO for the conference. Any registrations or payments made between now and Tuesday, will not receive notification of receipt until Tuesday, October 29th. Thank you!

If you have any questions about the conference registration form, please contact: Katy Lee Kemp, Webmaster
(KKemp@hsc.unt.edu)

If you have questions about the conference, please contact:
Alan Craig, NCLCA Vice President
(Alan.Craig@gpc.edu)



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:	*
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 30th 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: Research on the Fly- Jan Norton		Yes No
Wednesday, September 30th 2 PM- 5 PM: Pre-Conference Institutes C- E
Pre-Conference Institute C: Successful Practical Ideas for Math Learning Centers- Kathryn Van Wagoner		Yes No
Pre-Conference Institute D: Transitions to College- Jim Valkenburg and Jack Truschel		Yes No
Pre-Conference Institute E: Learning Center Peer Review- Jennifer Haley, Jackie Harris, Gary Ritz, et al.		Yes No
Saturday, October 3rd 8:30 AM- 12 Noon: Post-Conference Institute F
Post-Conference Institute F: Best Practices for Learning Centers- Frank Christ		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

Lunch with the President(s): Lunch with Dr. David Reedy (current NCLCA President) and Alan Craig (incoming NCLCA President)- Wednesday, Sept. 30th 12:15- 1:45 pm
Click here to attend this limited-seating luncheon and discussion with current and future NCLCA Presidents Wednesday, Sept. 30th from 12:15 PM- 1:45 PM ($25)		Yes No
Do you plan to attend the CLADEA Fellows Induction Banquet, Thursday, October 1st 6:30 PM ($30)	*	Yes No

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 11, 2009.
Conference Refund Policy: NCLCA will consider refund requests until September 22, 2009 (7 days prior to the start of the conference). Please request your refund in writing from the NCLCA Vice President Alan Craig (alan.craig@gpc.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
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