Download or print this form and submit with payment to:
Dr. Jon T. Kilpinen
Department of Geography & Meteorology
Valparaiso University
Valparaiso, IN 46383
| Name: | ________________________________________ |
| Affiliation: | ________________________________________ |
| Address: | ________________________________________ |
| City, State, Zip: | ________________________________________ |
| Phone: | ________________________________________ |
| E-Mail: | ________________________________________ |
Type of Participation (please check all that apply)
| ___ | I will present a paper. |
| Title:________________________________________________ | |
| ___ | I will present a poster. |
| Title:________________________________________________ | |
| ___ | I am entering the student paper competition. (Please circle one.) |
| Undergraduate | Master's | Ph.D. | |
| ___ | I will need the following audio-visual equipment: |
| _______________________________________________________ | |
| ___ | I will be attending, but not presenting a paper or poster. |
| ___ | I am willing to chair a session. |
| ___ | I am organizing a special session. |
| Topic:________________________________________________ |
Program Fees
| Registration fee (by October 1, 1996) | $35.00 | $_________ |
| Registration fee (after October 1, 1996) | $45.00 | $_________ |
| Student Registration fee | $10.00 | $_________ |
| Friday Evening Banquet | $20.00 | $_________ |
| Field Trip #1 -- "Walking Tour of Valparaiso" | Free | $_________ |
| Field Trip #2 -- "Michigan City" | $10.00 | $_________ |
| Field Trip #3 -- "The Kankakee Marsh" | $10.00 | $_________ |
| Field Trip #4 -- "The Indiana Dunes" | $10.00 | $_________ |
| Field Trip Special: Field trips 3 and 4 | $15.00 | $_________ |
| Thursday Afternoon Internet Workshop | $10.00 | $_________ |
| Total: | $_________ |