For Office Use Only
Date
Received
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The Loka Institute
Community Research Network 4th Annual Conference
"Re-shaping the Culture of
Research: People, Participation,
Partnerships & Practical
Tools"
University of Texas-Austin * July 6-8, 2001 * Austin, TX
(Download "ConfRegistrationForm.rtf") (Register on-line)
Conference Registration Form
(Please Print Clearly)
Name:__________________________________________________________________________________________
Organization:____________________________________________________________________________________
Preferred Mailing Address:_________________________________________________________________________
City:_________________________ State:________ Zip:_______________ Country:__________________________
Phone:_________________________________________ Fax:____________________________________________
Email:__________________________________________________________________________________________
Website:________________________________________________________________________________________
How did you hear about the conference?
____Direct Mail ____Electronic Mail ____Loka Website ____Word of Mouth ____Other_______________
Race/Ethnicity:__________________________________________________________________________________
(Your response is optional but we are committed to ensuring a diverse group of participants)
Are you ____Male ____Female (this information is needed for matching up roommates)?
Schedule
Thursday, July 5, 2001
7-9:30 PM, Reception
Friday, July 6, 2001
8:00 AM, Registration begins
9:00 AM-5:00 PM, Welcome Remarks, Plenary and Breakout Discussions.
5-7:00 PM, Dinner Break
8:00 PM, Evening Activity TBA
Saturday, July 7, 2001
9:00 AM 5:00 PM Plenary and Breakout Discussions.
5-7:00 PM, Dinner Break
8:00 PM, Evening Activity TBA
Sunday, July 8, 2001
9:00 AM 1:00 PM, Conference wrap-up and next steps.
Registration Fees: Registration fee is required in order to secure your space at the conference. Please submit with your registration form. Remaining balance (room and board) can be paid when submitting your form or at the on-site registration.
Institutional Registration Fee $125.00 ______
Regular Registration Fee $75.00 ______
Low-Income Registration Fee $25.00 ______
Voluntary Contribution to help fund a scholarship $___________
accommodations:
On-campus housing will be available in San Jacinto Residence Hall. All rooms have 2 single beds, private bath, a phone with free local service and Internet access, as well as micro-fridge. We encourage sharing a room when possible. The cost is $35 per person, per night. Reserved singles are $70 per night.
____I want to reserve a single room for nights of:___________________($70 per night) Total $______
____I want to reserve a double room for the nights of:_______________($35 per night) Total $______
My roommate will be:______________________________________________________
____I want to reserve a double room for the nights of:_______________($35 per night) Total $______
Please match me up with a roommate:________________________________________(for office use)
Board:
The following options are available for meals. Please choose.
Jester Center 2nd Fl Dining Room (located on 2nd Fl of Jester Center). Purchase meal tickets through Loka in advance at cost of $19.50 per day ($5.50 for breakfast, $6.50 for lunch and $7.50 for dinner) Unused balance on meal tickets is non-refundable.
Pay as you go meals are available at the Jester Center 2nd Floor Dining Hall as well as at the following locations:
Jester City Limits (1st Fl Food Court in Jester Center) providing a la Carte dining and pricing. Suggested budget of $20 per day to eat here, pay as you go.
Cypress Bend (Deli and Grille located in San Jacinto Hall) providing a la Carte dining and pricing.
Suggested budget of $20 per day to eat here, pay as you go.
____ I wish to take care of purchasing my own meals at one of the above dining halls.
____ I wish to purchase a full day meal ticket for Jester 2nd Fl Dining Room for the following days:
Days: _________________________________________X $19.50 per day = $_________________
____ Check here if planning on attending the Thursday night reception from 7-9 PM (complimentary)
Registration Fee Enclosed (needed to secure your space at the conference) $_________________
Room and board Enclosed (this can be paid at on-site registration) $_________________
Total Amount Enclosed ...$_________________
We cannot accept credit card payments. Please make checks payable to The Loka Institute.
Lokas Federal Tax ID #04-3334217.
While attending the conference, would you be interested in being a Notetaker for one or more of the workshops? We are looking for people who can take clear and comprehensible notes that will later be used in writing the 2001 Conference Report.
____ I would like to volunteer as a Notetaker
(If you volunteer, we will contact you in advance to discuss this in more detail)
Please use the space below to include a brief bio. This information will be used for the conference bio list unless you specify otherwise. (Please type or print clearly)
Space is Limited! You will be registered on a first come, first serve basis. When space is full, we will begin a waitlist. In this event you would be notified with an option of staying on the waitlist or being removed and your check returned.
Deadline for registration forms is June 15th, 2001. Forms sent by mail need to be postmarked no later than June 15th, and all faxed and emailed forms need to be received by 5PM on June 15th.
You will receive a confirmation letter in the mail upon receipt of your registration form and payment of registration fee.
NO REFUNDS ON REGISTRATION FEES WILL BE MADE AFTER JUNE 18, 2001.
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Send Completed Form and Check Payable to: The
Loka Institute * PO Box 355 * Amherst, MA 01004-0355 * USA QUESTIONS? Please see our website or contact The Loka Institute. (Phone) 413-559-5860 (fax) 413-559-5811 (Email) Loka@Loka.org (Website) www.Loka.org |
