MungerRegistration

I am :*
A Conference Attendee (Non-Student)
A Conference Presenter (Munger Conference or Advanced Workshops)
A Student Attendee (Full/Part-time at a College/University)
An IU Intern or Practicum Supervisor

Title:

First Name:

Last Name:

Employer Name:

Employer City:

Employer State:

Email:

Summer Contact Information

Please provide the information below where you can be contacted during May and June.

Please enter your email for summer access

Other Email (Summer access):

Home Address:

Home City:

Home State:

Home Zip:

Home Phone:

Conference Options

How did you learn about the conference ?:

Conference Selection :

I wish to attend : *

Munger Conference with Advanced workshops (4 days)

Or select individual days (choose 1 or more)

Monday, June 22

Tuesday, June 23

Wednesday, June 24

Thursday, June 25

Lunch

I will attend the free lunch on Tuesday, June 23 (required if you plan on receiving Graduate Credit, or want to receive the maximum CEUs/CRUs available for Tuesday, June 23).

I prefer a vegetarian meal

Other dietary restrictions:

Accomodation:

I would like a dormitory room for the following evening(s):

Monday (June 22)
Tuesday (June 23)
Wednesday (June 24)
Thursday (June 25)

Please note: You will need to pay for the rooms when you arrive at Willkie Hall.:

If you are staying in the dorm, please provide the following emergency contact information.:

Emergency Contact Name:

Emergency Contact Phone:

The dorm rooms share an adjoining bathroom with a member of the same sex. If you have a preference with whom you wish to share the bathroom with, please list the person's name here. We will do our best to accommodate your request.:

Parking:

I would like a free "A" pass to park on campus during the conference.
I need a handicap parking pass.

Conference Directory:

I prefer NOT to be listed in the Conference Directory.

Credit:

I plan on earning the following credit option(s):

CRUs
CEUs
Graduate Credit
     One credit
     Two credits
     Three credits

Please enter if you have any special needs

Do you have any special needs?:

This year's Munger Conference wants to better honor the work that you do in your profession. We hope to post appreciative quotes throughout the conference area. If you would feel comfortable with our contacting someone who is familiar with your work, so we can get a quote, please list a name and email address in the space provided.:

Reference Name:

Reference Email:

Payment Options

Please select a payment option. Based on your selections, your conference registration may be FREE. Select either option then click View Total. If your total is $0, you will not be asked to provide payment.:

Pay by credit/debit card on a secure server. Please help us keep conference costs down by choosing this option.

I cannot pay using a credit/debit card. Please send a bill and I will pay by check.

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