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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")

Conference E-Registration Form

(You are encouraged to register electronically, but your registration will not be complete until Loka has received full payment of registration fees)

 

:__________________________________________________________________________________________

Name

Organization

Street Address

Address:

City

State/Province

Zip

Country

Phone Fax

Email

Website

How did you hear about the conference? (Please select one)

Direct Mail Electronic Mail Loka Website Word of Mouth Other (fill in blank)

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)?

Fee Information: (Please forward your funds by postal mail as soon as possible to insure your registration will be processed.) Please select one.

Institutional Registration Fee $125.00

Regular Registration Fee $75.00

Low-Income Registration Fee $25.00

Accommodations: (Rooms will not be reserved until payment is received.)

I want to reserve a single room @ $70 per night for nights of:

I want to reserve a double room @ $35 per night for the nights of:

My roommate will be:

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 =

(All funds are US currency.)

I would like to volunteer as a Notetaker

 


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 room-mate: ________________________________________ (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.

Loka’s 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.

Send Completed Form and Check Payable to:

The Loka Institute * PO Box 355 * Amherst, MA 01004-0355 * USA
Attn: Conference Registration

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

 

 


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This page last modified: October 14, 2004 © The Loka Institute