Event Registration Form

Event Registration Form

Event/Course	Date
Teaching Institute	September 26-28
Assessment Institute	August 7-9
Course Design Institute	October 31-November 2
Activity Design Institute	December 5-7
Assessment Institute	January 23-25, 2009
Interactive Learning Systems Institute	February 27-28, 2009
Research on the Scholarship of Teaching and Learning Institute	April 10-12, 2009
Facilitator's Institute	May 15-17, 2009
Leadership Institute	June 30-July 2, 2009


What type of registration is this?	Event only ($600)	*Fee includes registration, event materials, and continental breakfasts and lunches.*
	Event with CEU credits ($800)
	Masters of Process Education credit ($1,200)
	I am registering as a participant from U-Mass.

* denotes a required field
* Name
* Dept/Discipline:
* Institution:
* Work Phone:
Home Phone:
Fax:
* E-mail:

For multiple person or group registration, enter a contact person or group representative in the fields at left and the remaining names, one name per line, below:

* Select Event:

	Teaching Institute	September 26-28
	Assessment Institute	August 7-9
	Course Design Institute	October 31-November 2
	Activity Design Institute	December 5-7
	Assessment Institute	January 23-25, 2009
	Interactive Learning Systems Institute	February 27-28, 2009
	Research on the Scholarship of Teaching and Learning Institute	April 10-12, 2009
	Facilitator's Institute	May 15-17, 2009
	Leadership Institute	June 30-July 2, 2009

* Method of Payment:

Please bill me. Use the following Purchase Order number:

I'll make my payment online via PayPal (credit card or PayPal account) after I submit this registration.

A check made payable to "Pacific Crest" is being sent to:

Pacific Crest
906 Lacey Ave. Ste. 211
Lisle, IL 60532

I am registering as a participant from the host school. My registration is being paid by my institution.

* Payment Amount:

Questions/Comments/Reasons for Attending: