Symposium on Service-Learning

Registration Form

June 3 - 5, 2014

Louisville Marriott

Louisville, Kentucky, USA

Three Easy Ways to Register:

Online 24 hours-a-day at:

Mail to: ACPA, Attention: Symposium on Service-Learning, One Dupont Circle, Suite 300, Washington, DC 20036

Fax to: 1.202.827.0601

ACPA Membership #:

Name:

Title:

E-mail Address:

Institution:

Mailing Address:

City, State, Zip:

Telephone:Fax:

Please indicate any special services, accommodations, or needs which may be necessary during the program (i.e. Sign Language interpreting, accessible materials, dietary restrictions). If more space is needed than provided, indicate below and continue on a separate sheet.

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ACPA Individual Member Rate___ $395 (postmarked or received by May 9, 2014)

___ $495 (postmarked or received after May 9, 2014)

Individual Non-Member Rate___ $595 (postmarked or received by May 9, 2014)

___ $695 (postmarked or received after May 9, 2014)

Student Member Rate___ $150 (postmarked or received by May 9, 2014)

___ $175 (postmarked or received after May 9, 2014)

Student Non-Member Rate___ $210 (postmarked or received by May 9, 2014)

___ $310 (postmarked or received after May 9, 2014)

Meals included: Continental Breakfast and lunch each day and dinner on Tuesday. Dinner Wednesday is "on your own".

Payment Method (sorry, we cannot accept purchase orders)

Check Money Order Credit Card

Circle type: VisaMasterCardDiscoverAmerican Express

Credit Card Number:

Expiration Date:

Name on card: (please print)

Cardholder Signature:

Total Registration: $

PAYMENT AND CANCELLATION POLICY

Registrations can be paid by check, VISA, MasterCard, Discover, or American Express. All fees must be prepaid. Purchase orders are not accepted. Refunds will be given for cancellations, received in writing at ACPA by May 12, 2014, less a $55 processing fee. After May 12, 2014, there are no refunds. ACPA reserves the right to charge a service fee of $50 for returned checks. A processing fee of $50 per registration will be charged for credit cards declined or to change payment methods after the initial payment is processed. The conference may be cancelled or postponed due to insufficient enrollment or other unforeseen circumstances. In this case, the fees will be fully refunded; however, ACPA will not be responsible for other additional costs, charges or expenses, including cancellation/change charges assessed by airlines and/or travel agencies.

Questions? Contact Tricia Fechter, ACPA Senior Director – Professional Development, Research & Scholarship, at 202.835.2272 or .

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