ACR 2004 Annual Conference Registration Form

Print out this page and mail or fax it in to the address listed below.

NOTE: If you are registering after September 15, 2004, please wait and register on site.

Registrant Information:

  

ACR ID #:

  

Name:

Nickname for Badge:

Title:

Organization:

Street:

State:

ZIP:

Daytime Phone:

Fax:

E-mail:

Special Needs:

I plan to attend as a Speaker only. I would like a Spanish Language interpretation for the sessions where it is available.

Registration Rates:

(circle the appropriate amount)

Registration Level

ACR Members

Non-Members

Main Conference - Early Bird (postmarked by August 9)

$340

$420

Main Conference - Second Chance (postmarked by September 1)

$395

$475

Main Conference (after September 1)

$440

$520

Full-Time Student (documentation required)

$175

$225

Youth (up to age 21)

$130

$130

Youth Chaperone (must be chaperoning two or more youth)

$245

$245

Exhibitor Registration (two per single or double booth)

$225

$225

Thursday only (daily pass)

$200

$250

Friday only (daily pass)

$200

$250

Saturday only (daily pass)

$200

$250

Wednesday Full-Day (6 hour) Pre-conference Sessions: PC1.01, PC1.02, PC1.03, PC1.04, PC1.05, PC1.06, PC1.07, PC1.08, PC1.09, PC1.10, PC1.11 (circle one)

$110

$110

Wednesday Morning (3 hour) Pre-conference Sessions: PC2.01, PC2.02, PC2.03, PC2.04 (circle one)

$55

$55

Wednesday Afternoon (3 hour) Pre-conference Sessions PC3.01, PC3.02 (circle one)

$55

$55

Govt. Voucher/DD Form 1556/Purchase Order

$10

$10

TOTAL Due:

    

Payment Information:

Check (drawn on U.S. Bank only)

    

Govt. Voucher/DD Form 1556/Purchase Order $10 additional charge.
(paperwork must accompany registration form in order for the registration to be processed)

Credit Card (circle one)

MasterCard

VISA

AmEx

Cardholders Name:

Telephone # of Cardholder:

Account Number:

Exp. Date:

  

Card Holder Signature (required):

   

Mail or Fax this form to:

Address:

ACR/2004 Conference
P.O. Box 25112
Arlington, VA 22202

Phone:

Fax:

E-mail:

703-685-4130

703-685-1144

acrconf@aol.com

  

(Please note that this address is not the main ACR Office.)

Association for Conflict Resolution | http://www.ACRnet.org