2008 Registration Form

institute logo

A collaboration of Ottawa Area ISD and Hope College

Held at the Haworth Center on Hope College campus, Holland, Michigan

Eighth Annual MIDWEST BRAIN & LEARNING INSTITUTE
One form per individual please.

Name:

Position/Job Title:

Grade level:

School/Agency/Organization:

Home Address:

City:

State:

Zip:

E-mail:

Home Phone:

Work Phone:

Do you wish to have your name and contact information published to an Institute networking list?

yes:

no:

Please register me for:
_____	Midwest Brain & Learning Institute -- $475.00 by May 15, 2008

_____	Early Bird Registration -- $425.00 by March 1, 2008 *(P.O.# must be paid in full no later than May 15, 2008.)*

_____	Post Institute Session on Friday morning -- part of tuition/SB-CEUs credit payment
Total Amount enclosed: $________________ P.O.#________________ There is additional cost for graduate and SB-CEU credits. See Credit Options section on Institute website.
____ I prefer vegetarian meals.

Make checks payable to Hope College. Payment or P.O # must accompany registration form. Early Bird registration closes, March 1, 2008.

Opening Day

One registration form per individual.

Please duplicate registration form if additional forms are needed.