Year 2003 Annual Conference Registration Form

DET/CHE 2003 ANNUAL CONFERENCE REGISTRATION FORM

December 3 - 5, 2003 ~ The RMS Queen Mary ~ Long Beach, California
Hosted by: California State University, Dominguez Hills, & Palomar College

Name: Title:

Institution/Organization:

Address (line 1):

Address (line 2):

City, State Zip Code

Daytime Telephone (w/ Area Code): FAX (w/ Area Code):

[  ] Yes, I am a DET/CHE Member ~ [  ] No, I am not a Member E-mail:

Conference Registration Fee (includes all meeting materials, breaks and designated meals)

___$275.00 full conference - member (2003-2004) ($300 after November 15, 2003)

_$325.00 full conference - non-member ($350 after November 15, 2003)

_$165.00 full conference - spouse/partner Name: _____________

_$  55.00 dinner banquet only for spouse/partner Driving Directions to Hotel

_$400.00 full conference--walk-ins (Not Recommended) Note: One-Day Rate: $150.00

_$75 membership dues for 2003-2004   (Not applicable to those paying the $325 registration fee)

_____Total Fees Due (Dues must be current for 2003-2004 in order to register as a member.)

Payment method: (payment to DET/CHE must accompany registration form)

[ ] check enclosed [ ] purchase order enclosed

Payment must be received before registration is considered complete. Dues must be current for 2003-2004 in order to register as a member.
Credit card payment cannot be accepted by DET/CHE.
To assist conference planning, please register as soon as possible.
Walk-in Registration is not recommended.
Cancellation Policy: If a registration is canceled by the registrant, a $55.00 service fee will be deducted from any payment. Registrants who do not attend or who cancel after the beginning of the conference are liable for the entire registration fee. Refund requests must be made in writing to the DET/CHE Treasurer, Susan Corum.

Special needs/assistance:

Special meal requirements:

Is this your first DET/CHE conference? [ ] Yes / [ ] No:

For further information about:
* Registration or about DET/CHE: (805) 893-8812; Bob Romanelli, DET/CHE Executive Office, UC Santa Barbara
* Program: (760) 744-1150, Ext. 1548; Marlene deLeon, Program Chair, Palomar College
* Local sites: (310) 243-2272; Warren Ashley, California State University, Dominguez Hills; and (310) 660-6712; Howard Story, El Camino College
* Sponsorship: (209) 667-3347; Brian Duggan, President, California State University Stanislaus
* The RMS Queen Mary Room Reservations: PLEASE CALL (562) 432-6964 DIRECTLY to get DET/CHE group rate of $109. Or, E-mail reservations@queenmary.com.
* Hotel Room Reservation Deadline: November 2, 2003. Conference Registration Deadline: November 15, 2003. See ROOM RESERVATION DETAILS.

Make your check payable to "DET/CHE" and mail this completed form & payment to:
Bob Romanelli
Instructional Resources
University of California Santa Barbara
Santa Barbara CA 93106-3200
(805) 893-8812 FAX (805) 893-5895. romanelli@id.ucsb.edu Main Conference Page

_______$275.00 full conference - member (2003-2004)	($300 after November 15, 2003)
_______$325.00 full conference - non-member	($350 after November 15, 2003)
_______$165.00 full conference - spouse/partner	Name: _____________________
_______$ 55.00 dinner banquet only for spouse/partner	Driving Directions to Hotel
_______$400.00 full conference--walk-ins (Not Recommended)	Note: One-Day Rate: $150.00
_______$75 membership dues for 2003-2004 (Not applicable to those paying the $325 registration fee)
_______Total Fees Due (Dues must be current for 2003-2004 in order to register as a member.)

Name:	Title:
Institution/Organization:
Address (line 1):
Address (line 2):
City, State	Zip Code
Daytime Telephone (w/ Area Code):	FAX (w/ Area Code):
[ ] Yes, I am a DET/CHE Member ~ [ ] No, I am not a Member	E-mail: