ITMS Conference Registration Form:

Open the Registration Form as a PDF Document

Name:        __________________________________________________________________

Address:    __________________________________________________________________

City:            ___________________________ State, Zip:   _____________________________

Phone:       _____________________        Email: ____________________________________


Registration Fees for the conference and all meals:

          □ ITMS Member - $340.00 - Please Phone To Confirm Availability - 502 272 8177 / 8099

          □ Non-Member - $400.00 - Please Phone To Confirm Availability - 502 272 8177 / 8099
          □ I prefer a vegetarian entrée at the banquet.
          □ Handicapped/special needs (attach explanation)  (Cancellation Policy)
 

$_______


Accommodation:
          □ $150.00 (single room for three nights - per person)
          □ $125.00 (shared room for three nights - per person)
               
          If sharing, preferred roommate: ________________________
 

 $_______


Additional Lodging Fee:
          □ Wednesday, June 3 - $50.00 (no meals)
          □ Sunday, June 7 - $50.00 (no meals)

 $_______


Daggy Scholarship Fund:
           Would you like to make a donation to the Daggy Youth Scholars Fund?
           Donations to the Daggy Scholarship Fund are tax deductible to the extent allowed by law.
 

 $_______


Total
(made payable to ITMS):  
 

 $_______

Please print and return this form, with check or money order, in US Dollars, made out to ITMS, to:
Paul M. Pearson
Thomas Merton Center
Bellarmine University
2001 Newburg Road
Louisville, KY 40205