By
7/21/15
After
7/21/15
Amount
Regular
$495
$545
_______
Full-time student (must send copy of student ID, institution, & department)
$285
$335
_______
Group (per person—minimum of 3 people)
$395
$445
_______
University Wisconsin System employee
$395
$445
_______
Fundamentals of Online Teaching Conference Certificate (must register by July 9)
$850
n/a
_______
$225/person or $450/group of 3
_______
$25
$30
_______
$95
$110
_______
$45
$55
_______
$95
$110
_______
$30
$40
_______
TOTAL
$ _________
2015 CONFERENCE REGISTRATION TYPES AND FEES
□
□
□
□
□
□
Virtual conference (NOTE: Group must include 3 names/3 email addresses)
Optional Tuesday Activities
□ Networking Lunch *Free with 2 half-day workshops
□ Morning Half-Day Workshops (8:30-11:30 am)
__AM-1 __AM-2
__AM-3
__AM-4 __AM-5 __AM-6
__AM-7
__AM-8
__AM-9 (90-minutes; online; 10-11:30 am)
□ Afternoon Half-Day Workshops (1:30-4:30 pm)
__PM-1 __PM-2
__PM-3
__PM-4 __PM-5 __PM-6
__PM-7
__PM-8
□ Workshop surcharge, if not attending conference
Roster
□Please omit my contact information from the roster.
Special dietary requests
□Vegetarian □Other _______________________________
The items below are included in conference fee, but you must pre-register.
Orientation to the Conference
□Will attend
□Will not attend
Special Interest Groups (SIGs) Both SIGs will meet Tuesday, August 11 at 1:30 pm.
□Military Education □Workplace Training & Development
□Will not attend
Thursday Lunch & Keynote, 11 am-12:30 pm □Will attend
Thursday Conference Finale w/desserts, 2:45-4 pm □Will attend □Will not attend
REGISTRANT INFORMATION (please print)
Name
Job title __________________
Organization
Business address
City/State/Zip/Country
Email ____________________________________________ Phone
PAYMENT METHOD
□ P.O. or check enclosed (Payable in U.S. funds to UW–Madison)
□ MasterCard
□ VISA
□ American Express
Cardholder’s Name
Card No.
Expires
WAYS TO REGISTER
• Online (may only pay by credit card)
https://dtlconference.wisc.edu
• Phone: 608.262.0810
• Fax: 800.741.7416 or 608.265.3163
• Mail: DT&L Conference
Pyle Center, Dept. 111
702 Langdon St., Madison, WI
53706
Cancellations & Refunds
Call Registration at 608.262.0810 to
cancel. If you do not attend and did not
cancel prior to the conference, you are
responsible for the total fee. If you
registered and cannot attend, you may
send a substitute.
• Cancel by 7/29/15: Full refund less $30
• Cancel by 8/04/15: 50% refund
• Cancel after 8/04/15: No refund
Please advise us at time of enrollment if
you have a disability and require special
accommodations. Requests are
confidential. If you need this material in
an alternate format, contact the
conference manager at 608.265.4159 or
the UWEX Affirmative Action at
608.262.0277.