mi Iowa AEYC

Online Individual Registration Form - Fall Institute 2017

(complete a form for each person attending)




State:







(PLEASE NOTE: confirmations and attendance certificates will be sent by email only.)

REGISTRATION FEES

(Check all that apply)

Thursday, September 21, 9:00 - 4:00 pm

(Space is limited for all pre-institute events. There is a $10 late fee for registrations received after 8/31.)
$45
$45
$45
$45
$45

Friday and Saturday, September 22-23

Registered on or before August 31
Registered after August 31
1 DAY-FRIDAY 1 DAY-SATURDAY BOTH DAYS    1 DAY-FRIDAY 1 DAY-SATURDAY BOTH DAYS
Member $70 $40 $100 $110 $90 $145
Non-Member $115 $115 $175 $150 $150 $225
Student $55 $45 $80 $75 $65 $100
If you are a member or employee of any of the following co-sponsoring organizations, you are eligible for the member rate (check all that apply)





MEALS - All attendees will receive one meal each day of attending the Institute

Special dietary needs (check all that apply):











FORM OF PAYMENT







FORM VALIDATION


If you would like a copy of your filled out registration form, please print this page before clicking submit. To total your fees and receive payment instructions, click the submit button below.