ITMS Conference Registration Form:

Open the Registration Form as a PDF Document

Name:        _________________________________________________________       

Address:    _________________________________________________________       

City:            ______________________ State, Zip:   _________________________

Phone:       ________________        Email: _______________________________

Name as you wish it to appear on your badge: _____________________________

Preferred Pronouns (optional): _________________________________________


Registration Fees for the conference and all meals (before May 15th):
           □ ITMS Member - $280.00

          □ Non-Member - $330.00

          □ I prefer vegetarian meals.

          □ Handicapped/special needs (attach explanation)  (Cancellation Policy)
 

$_______


Accommodation:
         
           □ $250.00 - Single room for three nights - per person
          □ $210.00 - Shared/double room for three nights - per person

          If sharing, preferred roommate: ________________________
 

 $_______


Additional Lodging Fee:
          □ Wednesday, June 18 - $85.00 per person (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:
Christopher Pramuk
Regis University
3333 Regis Boulevard, Main Hall B-6,
Denver CO 80221