Year 2003 Annual Conference Registration Form

DET/CHE 2004 ANNUAL CONFERENCE REGISTRATION FORM

November 30 - December 3, 2004 ~ The Claremont Resort ~ Berkeley, California
Hosted by: Mills College & UC Berkeley

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 (2004-2005) ($300 after November 15, 2004)

_$325.00 full conference - non-member ($350 after November 15, 2004)

_$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 2004-2005   (Not applicable to those paying the $325 registration fee)

_____Total Fees Due (Dues must be current for 2004-2005 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 2004-2005 in order to register as a member. Join DET/CHE: ONLINE APPLICATION. Pay Member Dues: Print INVOICE.
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/dietary needs:

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

For further information about:
* Registration or about DET/CHE: (805) 893-8812; Bob Romanelli, Executive Director, UC Santa Barbara.
* Program: (831) 459-3105; Henry Burnett, Program Chair, UC Santa Cruz.
* Local sites: (510) 643-8638; Victor Edmonds; UC Berkeley; and (510) 430-2211; James Graham.
* Sponsorship: (209) 667-3347; Brian Duggan, Past President, California State University Stanislaus.
* The Claremont Resort Room Reservations: CALL (800) 551-7266: be sure to request DET/CHE group rate of $129. (Arturo Javier is our reservation rep.)
* Hotel Room Reservation Deadline: October 29, 2004. Conference Registration Deadline: November 15, 2004.

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 (2004-2005)	($300 after November 15, 2004)
_______$325.00 full conference - non-member	($350 after November 15, 2004)
_______$165.00 full conference - spouse/partner	Name: _____________________
_______$ 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 2004-2005 (Not applicable to those paying the $325 registration fee)
_______Total Fees Due (Dues must be current for 2004-2005 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: