Name: ______________________________________________

Institution: _______________________________________________

Mailing Address: ___________________________________________

City, State, Zip: __________________________________________

E-mail address: ________________________________________________

I am an individual with a disability and will require the following accommodations(s):

______________________________________________________________________________________

Enclosed is a check/PO for ____$40 (active GADSPHE member) ____$50 (inactive or nonmember)

JOIN NOW for 2002 and receive the member rate for an additional conference!
Membership fee enclosed: ____$25 institutional     ___$10 professional
____$5 associate/student

Please print this registration form, complete, and send along with check or PO to
Carol Treible | Dalton State College | ACE Center | 213 North College Drive | Dalton, GA 30720.
DEADLINE:November 5.

Registrations received after November 5, add $10 for late fee. Lunch will not be provided for late or on-site registrations.

Cancellations should be communicated directly to Carol Treible at ctreible@em.daltonstate.edu.
Cancellations received after November 1 will not be able to be refunded.