2012 Mortar Board National Conference

ADVISOR REGISTRATION

REGISTRATION IS NOW OPEN!
REGISTRATION FOR THE 2012 NATIONAL CONFERENCE WILL OPEN ON MARCH 15, 2012

Conference dates: July 20 - 22, 2012
Deadline to register: May 15, 2012
If you register after May 15, your registration fee will increase by $75, which will be your personal expense.
CONTACT INFORMATION
First Name Last Name
Name as you would like it to appear on your name tag (first and last)
Gender Female Male
College/University
Chapter office/position
Summer street address
Summer street address 2, if necessary (Apt, floor, suite, etc. )
Summer city State ZIP
Summer phone number   Cell phone number
Email address   Secondary email
CONFERENCE/TRAVEL INFORMATION

Information about your travel arrangements
The cost for your travel is not paid by Mortar Board. You must make your own travel arrangements.

The conference begins at 3 p.m. on Friday, July 20 and concludes at noon on Sunday, July 22. If you would like to take advantage of our preconference workshop opportunities, you may need to arrive on Thursday, July 19. More information is available below.
DIETARY REQUIREMENTS
Indicate any special dietary requirements.
Food allergy:
Vegetarian
Vegan
Other (please describe in detail):

CHAPTER SOLUTIONS WORKSHOP

Chapter Solutions Workshop (Friday, July 20; 8 a.m. - 1 p.m.)
This workshop is designed specifically for official delegates, collegiate participants and advisors from struggling chapters who are interested in intensive, hands-on problem solving. Join us for a day filled with one-on-one training and facilitation provided by Mortar Board collegiate chapter members and national leaders. 

You will spend the day developing strategies to increase your membership numbers, find an advisor and develop strength and visibility on campus. Specific ideas for fundraising, campus programming and building chapter stature are woven through this great chapter coaching experience.

There are no additional registration fees for Chapter Solutions; the only additional cost is if you plan at arrive in Chicago on Thursday and will need an additional night's accommodation. Because Chapter Solutions will start at 8 a.m. on Friday, we strongly encourage participants to arrive on Thursday. Prices are based on double-occupancy accommodations. A single-occupancy room may be requested at the participant’s expense, as noted below.


Chapter Solutions registration options
Thursday arrival, accommodations for Thursday night- $65 (Add $65/night for single-occupancy accommodations.)
Friday arrival - no additional charge
T-SHIRT SIZE
Each participant is provided at no charge with a 2012 Mortar Board National Conference t-shirt. Please select your size below to ensure that appropriate quantities of sizes can be provided. Sizes requested after the May 15 deadline may not be available.
Size: Other
CHAPTER DISPLAY

Each chapter is given the opportunity to create a display at the conference either by bringing or shipping and existing display, or using a tri-fold board (provided upon arrival if reserved in advance) and materials they bring. Official delegates are asked to request the display preferences on behalf of their chapter. If you have questions about whether or not your chapter's delegate requested adequate space, please call 800-989-6266 ext. 104.
ACCOMMODATION OPTIONS
By default, each conferee will be assigned a double-occupancy, nonsmoking room with another conferee of the same gender. Roommate requests are permitted. Those who choose to pay an additional fee of $65 per night will be assigned a single room. If you would like to take advantage of these accommodation options, please use the fields below.
Roommate request:
I request a roommate - Name: College/University:

Single room request:
I request a single room ($65/night) at the conference hotel for part or all of my stay. I would like to reserve a single room for the following nights (please check all that apply):
Thursday Friday Saturday

Option to not stay at conference hotel:
I live in Chicago and will not be staying in the conference hotel.

PAYMENT INFORMATION

Please select your payment method from the list below. Keep in mind that the following fees apply:

  • Advisor registration - $245
  • Chapter Solutions Workshop, Thursday arrival- $65 (add $65/night for single room)
  • Single room fee - $65/night (Conferees are required to stay at the hotel for two nights, July 20 and 21, for a total single room fee of $130; Conferees who request a single room and choose to arrive on Thursday, July 19 will be required to pay the single room nightly fee for that night as well.)
I do not owe any fees and payment is not necessary.
PayPal - On the next page, you will be given the option to pay your registration and single room fees using PayPal.
Check - Please send any checks to the Mortar Board National Office at 1200 Chambers Road, Suite 201; Columbus, OH 43212
Will Call - Please select this method if you would like to pay by credit card over the phone. You may call the National Office at 800-989-6266 ext. 103 to give your credit card number.
Please calculate your total amount due and enter it here
SPECIAL ACCOMMODATIONS

If you require special accommodations to help you attend this meeting, please describe your needs below and a National Office staff member will contact you by phone or email to help with any arrangements. If you have not requested special accommodations before May 16, Mortar Board reserves the right not to provide them.
ACCEPTANCE OF RESPONSIBILITY AND WAIVER OF LIABILITY/PHOTO RELEASE

1. Waiver of liability. I hereby release, discharge, hold harmless, and acquit Mortar Board and its staff and officers and their agents and assigns and Mortar Board’s partners, sponsors, exhibitors and their officers, agents, representatives, employees and assigns from any actions, causes of action, claims or liabilities, now existing or that may arise in the future, that are in any way related to or arise out of my participation in or travel to or from the conference.

2. Photo permission. I grant my permission for my photograph or likeness to be used for promotional purposes of Mortar Board without any expectation of prior approval or compensation.

3. Directory information. I grant my permission for my contact information to be shared with other conference participants in a printed directory made available at the conference.
 
If you do not want your contact information to be shared with other delegates, please check this box.
Agree to 1-3 above by initialing here     Date
 

 
You should print or save copy of this form for your records.