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 (before April 15
th):

          □ ITMS Member - $350.00

          □ Non-Member - $400.00

          □ I prefer a vegetarian entrée at the banquet.
          □ Handicapped/special needs (attach explanation)  (Cancellation Policy)
 

$_______


Accommodation:
         

          □ $175.00 - Single room for three nights - per person
          □ $125.00 - Shared/double room for three nights - per person

          If sharing, preferred roommate: ________________________
 

$_______


Additional Lodging Fee:
         
Wednesday, June 26 - $75.00 (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:
Natalie Terry
Thomas Merton Center

2001 Newburg Road.

Louisville KY 40205