2011 ELA Annual Conference Registration

Please complete all information below. If you prefer to register by fax or mail, please print a hardcopy. If you have any questions, please call us at (937) 229-3589. Visit our Conferences page for more information about the 2011 ELA 57th Annual Conference.

Note: Please use the Tab key when moving to the next field. Pressing the Enter key at any time will submit the form.

Registrant Information:
             1. Full Name:
             2. Title:
             3. Nickname to appear on nametag:
             4. Institution or Firm:
             5. Address:
                
             6. City: 
             7. State:     8. Zip Code:
             9. Country: 
             10. Is this address: Home Business Other
             11. Phone:
             12. Fax: 
             13. Email: 
Registration Information:
             1. Registration Type:
                  Regular ELA Member Registration (must hold current ELA Membership) - $340
                         
                  New Member Conference Registration - $490
                         (this includes a one-year new ELA membership)
                         
                  Regular Nonmember Registration - $500
                          
                  Student Registration (must hold current ELA Membership) - $175

                  Retired Registration (must hold current ELA Membership) - $175
             Please check all that apply:
                  Early Registration (registration fee paid by September 1, 2011): -$25

                  I am a first-time conference attendee

                  Please check here if you require special accommodations to fully
                         participate. Please include a written description of your needs in
                         the box below:
                         

          
             2. Optional. Wednesday General Preconferences - $75/session):
                  (Select one):    Collective Bargaining  or Higher Education                                         
             3. Optional. Continuing Legal Education Credit ($40/state):
                    CLE Bar Number:
             4. Optional. Role-Alike Lunch - Join your constituency group colleagues
                 for a casual lunch and a relevant discussion on current topics. There is
                 no additional cost for paid registrants, but if you plan to attend the role-
                 alike lunch, you must select a group below in order to receive a lunch
                 ticket:
                
Bringing a guest? You can purchase guest tickets for the following events:
             5. Optional. Additional Role-Alike Guest Tickets ($40 / ticket):
                 (no additional cost for paid registrants)
                
             6. Optional. Additional Wednesday Evening Reception Guest Tickets ($50 /
                  ticket) (no additional cost for paid registrants):
                

             7. Optional. Additional Thursday Evening Reception Guest Tickets ($50 /
                  ticket) (no additional cost for paid registrants):
                

             8. Optional. Additional Business Meeting Breakfast Guest Tickets
                 ($40 / ticket) (no additional cost for paid registrants):
                
             10. Payment Type:                 

                  Credit Card. Call us with your credit card number: (937) 229-3589. We are updating
                          our system and will be able to take your credit card online very soon.

                   If you select the payment options below , you are not considered as
                   registered until we receive payment.

                  Invoice Me (purchase order number required)
                 
                  Check or Money Order
                          (Make payable to Education Law Association)