PKC 2003 Registration
January 6-8, 2003 - Miami,
Florida, USA
Instructions:
To register for PKC 2003, you may FAX or post this
completed form with payment to:
PKC 2003 Conference Registrar
Center for Professional Development, Florida State
University
Tallahassee, FL 32306, USA
FAX number: 1+ (850) 644-3803 with
credit card payment information. We cannot accept registrations by email.
Personal Information
|
|
Name:______________________________________________________________________________________________ |
|
Affiliation:___________________________________________________________________________________________ |
|
Address:____________________________________________________________________________________________ |
|
_____________________________________________________________________________________________ |
|
Phone:______________________________________________________ FAX:____________________________________ |
|
Email:________________________________________________________________________________________________ |
Conference Registration
a. |
Full Time Student |
$240 |
[ ]
|
b. |
Regular Registration Fee |
$580 |
[ ]
|
c. |
Extra Copy of Proceedings |
$ 60 |
[ ] |
Paper Charges (For Accepted Authors): Select the appropriate amount –
No more than14pgs, no charge; 15pgs, $90 [ ]; 16pgs, $160
[ ]; 17pgs, $250 [ ]; 18pgs $320 [
].
IF YOUR REGISTRATION IS
POSTED AFTER December 1st, 2002
- ADD $100 [ ]
TOTAL
AMOUNT DUE (US Dollars only): $_______________
Payment - We accept checks IN US DOLLARS
DRAWN ON A US BANK made payable to Florida State University, or credit cards. You MUST
include your payment in full when you return this form. If you choose to pay by
credit card, complete the following.
Card
Type: |
Visa
[ ]
MasterCard [ ] Discover [ ] American Express
[ ] |
Card
Number: |
|
Expiration
Date: |
______________________________________________________________ |
Name
on Card: |
______________________________________________________________ |
Cardholder’s
signature: |
______________________________________________________________ |
Personal Information: The personal contact
information that you provide will be published in the conference attendee list.
It is NOT made available to any other organization in electronic form. If you
do NOT want your contact information to be published in the conference attendee
list, choose this box: I DO NOT WANT MY DETAILS
PUBLISHED
[ ]
Cancellation Policy: Cancellations
received by December 1st will be considered for a refund less a cancellation
charge of $100, and $60 to cover a copy of the conference proceedings. No
refunds will be made for cancellations received after December 1st. A copy of
the proceedings will be mailed to all those who registered but did not attend.
You
can also register online at learningforlife.fsu.edu.