GLPTI - Conference Registration

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A * denotes a required field

What type of registration would you like?* Conference Registration - $110.00 for Full Institute or Daily rate of $55.00/day

Attendee Personal Information

Full Name: *

Title:

Park District/Agency:

Address:

City:

State:

Zip:

Phone: * () - - ext.

Fax:

Email:

Is this your first Great Lakes Park Training Institute? * Yes
No

CEU's Information * Yes, I would like CEU's for $10.00
No, I do not want CEU's

Name: *

Title:

Park District/Agency:

Address:

City:

State:

Zip:

Birthdate:

Gender:

Conference Registration Fees *

Full Institute - $110.00
Daily Rate - $55.00/day

Check the days for your enrollment: *

Monday
Tuesday
Wednesday
Thursday

Would you like a copy of your proceedings for $15.00? *

Yes.
No, thanks.

GLPTI Registration Payment Option*

By Credit Card
By Check/Money Order
Purchase Order

Purchase Order #:

2007 Great Lakes Park Training Institute. Copyright 2006, the Trustees of Indiana University.